Clinical Observation Of Low-dose Tacrolimus In The Treatment Of Refractory Lupus Nephritis

Objective:To investigate the efficacy and safety of tacrolimus in the treatment of refractory lupus nephritis(LN).Methods:16patients with refractory LN were randomly divided into tacrolimus group and multitarget treatment group. The multitarget treatment group was treated with tacrolimus plus CTX. The dose of tacrolimus of both groups were2mg/d, administered in two divided doses. The multitarget treatment group used CTX0.6-1.2g/m. Prospective data on Up/cr, routine blood and urine tests, hepatic functions, renal functions and adverse events were collected for24weeks. Divided the efficacy into complete response(CR), partial response(PR) and no response(NR) according to the data above.Results:Complete or partial response was observed in66.7%of patients receiving tacrolimus therapy at24weeks, including one CR and three PR(2cases exited before the end of the experiment, so there were6cases that completed the experiment in tacrolimus group). The Complete or partial response was observed in50%of patients in multitarget treatment group, all of which were PR. There was no difference in CR, PR and total efficiency between two groups. Up/cr significantly reduced in both groups after24weeks. Significant improvement in albumin levels and notable decrease in SLEDAI scores and positive rate of anti-dsDNA were observed in multitarget treatment group. The tacrolimus group had adverse events(AE) occurred in5cases, while the cases of AE were6in the multitarget treatment group. There was no difference in total AE between two groups.2cases of tacrolimus group developed severe renal insufficiency in sixth and eighth weeks respectively.4cases appeared gastrointestinal reaction in multitarget treatment group, which was higher than in tacrolimus group. No cases experienced reccurence in both groups.Conclusion:Both tacrolimus group and multitarget treatment group had good effects on refractory LN, both can decrease proteinuria effectively. Multitarget therapy was better in improving albumin levels and SLEDAI scores. There was no difference in total AE between two groups, while gastrointestinal discomfort happened more frequently in multitarget treatment group.