Biologics: a target therapy of lupus nephritis: a systematic review

Abstract

Objective To review the use of biological management of lupus nephritis (LN). Data sources A systematic review of Medline (PubMed, Medscape, Science Direct, and EMF-Portal) and Internet was conducted on all articles published from 2006 to 2017. Study selection English-language reports on biological management of LN were searched. The initial search presented 150 articles, where 30 satisfied the inclusion criteria. Data extraction Articles not reporting on biological management of LN in the title or abstract were not included. A total of five independent investigators extracted data on methods. Data synthesis Comparisons were made by structured review, with the results tabulated. Overall, seven studies were about traditional therapy, 14 about biological therapy, and seven about evidence-based treatment for LN. Findings The various biological agents consisted of anti-B-cell therapies targeting either B-cell surface antigens or B-cell survival factors, anticytokines antibodies, and novel drugs intervening in B-T cell costimulation. Use of leflunomide in LN was found to be equally efficacious and safe at least in short term and in refractory LN. Immunosuppressive treatment should be guided by renal biopsy, and treatment aimed at complete renal response. Conclusion Biologicals, especially rituximab, although still off the shelf as an induction agent, can be used for resistant LN. Overall, treatment has to be individualized, multidisciplinary, and holistic to prevent loss-of-organ function.