Efficacy of tacrolimus combined with glucocorticoid for inductive therapy of diffuse proliferative lupus nephritis

Abstract

Objective To investigate the efficacy and safety of tacrolimus combined with glucocorticoid for inductive therapy of diffuse proliferative lupus nephritis. Methods Thirty-eight patients with diffuse proliferative lupus nephritis were randomly divided into study group (19 cases) and control group (19 cases) ,and they received the treatment of tacrolimus combined with glucocorticoid and cyclophosphamide combined with glucocorticoid respectively. The changes of laboratory tests and adverse reactions before and after treatment were observed. Results After treatment for 9 months, the systemic lupus erythematosus disease activity index, urinary protein quantitation, urinary sediment RBC count and anti-dsDNA positive rate in two groups were significantly decreased than those before treatment (P ＜0.05). While serum albumin, complement C3 and G4 levels were significantly increased than those before treatment (P＜0.05). Urinary protein quantitation in study group decreased more significantly than that in control group, while serum albumin increased more significantly than that in control group, and the differences were statistically significant(P＜ 0.05). The effective rate in study group[94.7%(18/19)] was significantly higher than that in control group[68.4%(13/19)](P＜ 0.05). The duration to obtain complete remission and partial remission in Emaii:mashangminpl@163.comstudy group was significantly shorter than that in control group(P＜ 0.05). Nobody withdrawed from the study due to serious side effects of drug. The incidence rate of transient increase in SCr and abnormal glucose metabolism in study group was higher than that in control group, and the incidence of infection and elevated liver enzymes was lower than that in control group. In addition, menstrual disorders and reduction of blood WBC did not occur in study group, but the incidence rate of side effects between two groups had no significant difference (P＞ 0.05). Conclusion Tacrolimus is an effective immunosuppressant for inductive therapy of diffuse proliferative lupus nephritis with quick response and less adverse effects. Key words: Lupus nephritis; Cyclophosphamide; Tacrolimus