The Evolution of Lupus Nephritis Treatment; from Conventional to Targeted and Biologics Therapy

Lupus nephritis (LN) is a common and severe organ manifestation in patients with systemic lupus erythematosus (SLE). LN can present alone or with accompanying extra-renal symptoms. The prevalence and severity vary depending on ethnicity, genetics, and environmental exposure. However, the presence of LN in SLE is a surrogate indicator of disease severity, frequent relapse, increased chronic kidney disease (CKD), and mortality risks. The current conventional standard treatments for LN include corticosteroids, immunosuppressive drugs, and antimalarial drugs. Despite an optimal standard treatment regimen, the outcomes of renal remission, decreased CKD risk, and quality of life are unsatisfactory. In addition, corticosteroid and immunosuppressive drug toxicity are of primary concern. Thus, two dozen promising biological and targeted drugs are being studied in the LN treatment pipeline to improve renal outcomes and mitigate the side effects of conventional therapy. This article aims to review the pathogenesis of LN, summarise the current conventional strategy, and highlight the candidate novel drugs in LN included in Phase II and III clinical trials. These biologics, or targeted therapies, are hoped to facilitate the advancement of the LN treatment paradigm in the era of precision medicine.