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