Sirolimus may be used as an alternative to prednisolone in patients with lupus nephritis
Sirolimus demonstrates an acceptable long-term safety profile and may be used as an alternative treatment for patients with lupus nephritis (LN) who cannot tolerate standard treatment or who had a history of malignancy, a recent study suggests.
The investigators retrospectively reviewed 16 class III/IV/V patients with LC who had received prednisolone and sirolimus either as initial or maintenance treatment.
Sirolimus was administered to 16 patients (nine due to intolerance to standard immunosuppressants and seven due to a history of malignancy) for 45.3±36.5 months.
Five patients received sirolimus and prednisolone as induction for active nephritis, and they had improvements in proteinuria (2.8±1.9 g/day at baseline; 0.1±0.1 g/day after 36 months; p=0.011), anti-dsDNA (107.7±91.9 and 37.0±55.4 IU/ml, respectively; p=0.178) and C3 (54.8±26.1 and 86.3±18.6 mg/dl, respectively; p=0.081).
Eleven patients received sirolimus and low-dose prednisolone as long-term maintenance, with both showing continued improvement in C3 (90.4±18.1 and 117.7±25.1 mg/dl at commencement and after 36 months, respectively; p=0.025), stable renal function (estimated glomerular filtration rate, 58.6±25.8 and 63.0±29.6 ml/min, respectively; p=0.239) and proteinuria (0.8±0.7 and 0.7±0.7 g/day, respectively; p=0.252).
One patient had renal flare, and another who had stage IV chronic kidney disease when initiating sirolimus developed end-stage renal failure after 27 months. Five patients ceased use of sirolimus, with four cases related to side effects. Furthermore, four patients had deterioration of dyslipidaemia but was adequately controlled with statins.
“Our pilot short-term data suggested efficacy of sirolimus treatment in these patients,” the investigators said.