Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis
Identifieur interne : 001692 ( Main/Exploration ); précédent : 001691; suivant : 001693Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis
Auteurs : Stephen D. Marks [Royaume-Uni] ; Kjell Tullus [Royaume-Uni]Source :
- Acta Pædiatrica [ 0803-5253 ] ; 2010-07.
Abstract
There is still a significant morbidity and mortality associated with childhood‐onset systemic lupus erythematosus (SLE), despite an increasing armamentarium of immunosuppressive agents. The ideal therapeutic strategy for children and adolescents with SLE should provide the right amount of treatment to allow normal growth, development and fertility while reducing the disease activity and damage that can be accrued over the years. Each patient should have individualized treatments tailored to their organ involvement, disease severity and history of flares together with recent clinical, haematological and immunological parameters to avoid further flares of disease activity and side‐effects of treatment, especially severe infections and future malignancies. The most commonly cited side‐effects of medications include Cushingoid features of corticosteroids, infective complications of cyclophosphamide and gastrointestinal side‐effects of mycophenolate mofetil. There is increasing evidence to support the use of oral mycophenolate mofetil as opposed to cyclophosphamide for both induction and maintenance therapies in many children with SLE with or without lupus nephritis (LN). Recently, case series utilizing B‐lymphocyte depletion therapies with rituximab look promising for patients with severe or refractory disease activity. In this article, we explore current evidence to effectively treat children and adolescents with SLE with or without LN. Conclusion: Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab.
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DOI: 10.1111/j.1651-2227.2010.01771.x
Affiliations:
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Marks</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Tullus, Kjell" sort="Tullus, Kjell" uniqKey="Tullus K" first="Kjell" last="Tullus">Kjell Tullus</name><affiliation wicri:level="3"><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Acta Pædiatrica</title><title level="j" type="alt">ACTA PAEDIATRICA</title><idno type="ISSN">0803-5253</idno><idno type="eISSN">1651-2227</idno><imprint><biblScope unit="vol">99</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="967">967</biblScope><biblScope unit="page" to="974">974</biblScope><biblScope unit="page-count">8</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-07">2010-07</date></imprint><idno type="ISSN">0803-5253</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0803-5253</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">There is still a significant morbidity and mortality associated with childhood‐onset systemic lupus erythematosus (SLE), despite an increasing armamentarium of immunosuppressive agents. The ideal therapeutic strategy for children and adolescents with SLE should provide the right amount of treatment to allow normal growth, development and fertility while reducing the disease activity and damage that can be accrued over the years. Each patient should have individualized treatments tailored to their organ involvement, disease severity and history of flares together with recent clinical, haematological and immunological parameters to avoid further flares of disease activity and side‐effects of treatment, especially severe infections and future malignancies. The most commonly cited side‐effects of medications include Cushingoid features of corticosteroids, infective complications of cyclophosphamide and gastrointestinal side‐effects of mycophenolate mofetil. There is increasing evidence to support the use of oral mycophenolate mofetil as opposed to cyclophosphamide for both induction and maintenance therapies in many children with SLE with or without lupus nephritis (LN). Recently, case series utilizing B‐lymphocyte depletion therapies with rituximab look promising for patients with severe or refractory disease activity. In this article, we explore current evidence to effectively treat children and adolescents with SLE with or without LN. Conclusion: Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Marks, Stephen D" sort="Marks, Stephen D" uniqKey="Marks S" first="Stephen D" last="Marks">Stephen D. Marks</name></region><name sortKey="Tullus, Kjell" sort="Tullus, Kjell" uniqKey="Tullus K" first="Kjell" last="Tullus">Kjell Tullus</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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