Tacrolimus Possibly Beneficial Long Term in Lupus Nephritis

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Over a 5-year period, the drug was well tolerated and associated with significant declines in urinary protein-creatinine ratio and mean prednisolone dose.
Over a 5-year period, the drug was well tolerated and associated with significant declines in urinary protein-creatinine ratio and mean prednisolone dose.

Tacrolimus may be effective for the long-term treatment of lupus nephritis (LN), results from a retrospective study suggest.

Kazunori Karasawa, MD, and colleagues at Tokyo Women's Medical University reported outcomes from 23 patients with LN who were treated with tacrolimus over a 5-year period. The mean urinary protein/creatinine ratio decreased significantly from 0.24 at baseline to 0.00 at 5 years, the investigators reported online ahead of print in Rheumatology International. The estimated glomerular filtration rate remained stable during the study period. It was 105 mL/min/1.73 m2 at baseline and 92 mL/min/1.73 m2 at 5 years, a non-significant decline.

The mean modified lupus nephritis disease activity index decreased significantly from 3.00 at baseline to 2.00 at 5 years. During that interval, the mean prednisone dose decreased significantly from 0.33 mg/kg/day at baseline to 0.15 mg/kg/day.

Tacrolimus was started at a dose of 3 mg/day after induction therapy. The dose was well tolerated throughout the study.

The authors concluded that tacrolimus is effective for maintenance treatment for LN, particularly for patients who do not respond to other immunosuppressants.

The study initially enrolled 26 patients (25 female) with a mean age of 50.3 years. Three patients discontinued tacrolimus because of related complications, including acute myeloblastic leukemia, tremor, or a general personal choice or desire to become pregnant, Dr Karasawa and colleagues reported.

Reference

Karasawa K, Uchida K, Kodama M, et al. Long-term effects of tacrolimus for maintenance therapy of lupus nephritis: a 5-year retrospective study at a single center. Rheumatol Int. 2018; published online ahead of print.

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