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Table 1 Standard immunosuppressive drugs for induction and maintenance therapy of ISN/RPS class III/IV/V lupus nephritis

From: Therapy of lupus nephritis: lessons learned from clinical research and daily care of patients

Drug Route Dose Induction Maintenance
Glucocorticoids Oral 0.5-1.0 mg/kg per day
Prefer 0.5 mg/kg per day
Required
Combined with another IS
Advised
Low-dose (5-7.5 mg/day)
  IV 500-1,000 mg MP Advised
3 consecutive days
Optional (every month to every 3 months)
Consider in non-compliant patients
Cyclophosphamide Oral 2 mg/kg per day Only for highly selected severe cases No
  IV NIH 500-1,000 mg/m2
Six monthly pulses dose adjusted (WBC count nadir)
Mesna advised
Reasonable first choice No
  IV EL 500 mg fixed dose
Six fortnightly pulses
Reasonable first choice NA
Mycophenolate mofetil Oral 1-3 g/day
Target 2-3 g/day
Reasonable first choice
Preferred for non-Caucasians, non-Asians
Reasonable first choice
Azathioprine Oral 1.0-2.5 mg/kg per day
Target 2.0-2.5 mg/kg per day
Not first choice Reasonable first choice
Calcineurin inhibitors Oral Cyclosporine: 2.5-3.0 mg/kg per day
Tacrolimus: 0.05 mg/kg per day
Not first choice Selected cases
Pure membranous lupus nephritis
Plasma exchanges NA 2-4 L/session
Twice weekly, then weekly
Selected cases No
  1. EL, Euro-Lupus; IS, immunosuppressant; ISN/RPS, International Society of Nephrology/Renal Pathology Society; IV, intravenous; MP, methylprednisolone; NA, not applicable; NIH, National Institutes of Health; WBC, white blood cell.