Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis
Article first published online: 11 MAR 2010
© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Pædiatrica
Volume 99, Issue 7, pages 967–974, July 2010
How to Cite
Marks, S. D. and Tullus, K. (2010), Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis. Acta Paediatrica, 99: 967–974. doi: 10.1111/j.1651-2227.2010.01771.x
- Issue published online: 1 JUN 2010
- Article first published online: 11 MAR 2010
- Received 6 October 2009; revised 18 January 2010; accepted 11 February 2010.
- Lupus nephritis;
- Systemic lupus erythematosus;
There is still a significant morbidity and mortality associated with childhood-onset systemic lupus erythematosus (SLE), despite an increasing armamentarium of immunosuppressive agents. The ideal therapeutic strategy for children and adolescents with SLE should provide the right amount of treatment to allow normal growth, development and fertility while reducing the disease activity and damage that can be accrued over the years. Each patient should have individualized treatments tailored to their organ involvement, disease severity and history of flares together with recent clinical, haematological and immunological parameters to avoid further flares of disease activity and side-effects of treatment, especially severe infections and future malignancies. The most commonly cited side-effects of medications include Cushingoid features of corticosteroids, infective complications of cyclophosphamide and gastrointestinal side-effects of mycophenolate mofetil. There is increasing evidence to support the use of oral mycophenolate mofetil as opposed to cyclophosphamide for both induction and maintenance therapies in many children with SLE with or without lupus nephritis (LN). Recently, case series utilizing B-lymphocyte depletion therapies with rituximab look promising for patients with severe or refractory disease activity. In this article, we explore current evidence to effectively treat children and adolescents with SLE with or without LN.
Conclusion: Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab.