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 |