Which cytotoxic agents are most frequently used for maintenance therapy in the treatment of lupus nephritis

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Which cytotoxic agents are most frequently used for maintenance therapy in the treatment of lupus nephritis?

• Maintenance therapy is given after induction therapy for prolonged response

• Typically, oral AZA (up to 2 mg/kg/day) (or 6-mercaptopurine if nausea on AZA) or MMF generally preferred (1–3 g/day)

• Avoid AZA in patients on allopurinol (gout) or on warfarin (warfarin resistance)

• CYC IV every 3 months after induction can be given in patients who cannot tolerate AZA or MMF.

• Prednisone is tapered over time to dose that controls renal and extrarenal manifestations

• Maintenance therapy is recommended for at least 1–2 years (or longer) post-induction

• Other maintenance therapies

• Rituximab: limited data

• Calcineurin inhibitors (cyclosporine, tacrolimus): alone or combined with low-dose MMF

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