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When should targete...
When should targeted therapies be used in the treatment of lupus nephritis : Early in the disease course or in refractory patients?
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- Parodis, Ioannis, 1981- (author)
- Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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- Depascale, Roberto (author)
- Deparment of Medicine DIMED, Division of Rheumatology, University of Padua, Padua, Italy
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- Doria, Andrea (author)
- Deparment of Medicine DIMED, Division of Rheumatology, University of Padua, Padua
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- Anders, Hans-Joachim (author)
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
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(creator_code:org_t)
- Elsevier, 2024
- 2024
- English.
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In: Autoimmunity Reviews. - : Elsevier. - 1568-9972 .- 1873-0183. ; 23:1
- Related links:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Subject headings
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- Although the prognosis of lupus nephritis (LN) has improved over the last few decades, 5-20% of patients still progress to kidney failure. Hence, there is an unmet need to improve the management of LN. Two novel drugs, belimumab and voclosporin, have been recently approved for LN and obinutuzumab is in the late stage of development. In randomised controlled trials (RCTs), all these drugs, added to the standard-of-care, were more effective than standard-of-care alone in achieving renal response. Now the question is: should these new drugs be used early in the disease course or just in refractory patients? The main reasons supporting the early use are based on the RCTs that demonstrated benefits when combinatory regimen was initiated early in incident and relapsing patients leading to a higher proportion of patients to achieve renal response, hence reducing nephron loss and the risk of kidney failure. The main reasons supporting the use of the combinatory regimens primarily in relapsing/refractory patients acknowledge that many patients responded well even without add-on medications, allowing a more economic use of innovative and costly drugs. However, good predictors of renal response to standard-of-care are lacking and, thus, the decision of adding new treatments early or just in refractory or relapsing patients has to consider drug access, risks of over or undertreatment, and preservation of kidney function in high-risk individuals.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- Biological drugs
- Combination therapy
- management
- Lupus nephritis
- Systemic lupus erythematosus
Publication and Content Type
- ref (subject category)
- for (subject category)
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