Sirolimus-based induction therapy for lupus nephritis: A single-arm, open-label pilot clinical trial

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of childbearing age and poses significant long-term health challenges.Among its diverse manifestations, lupus nephritis (LN) stands out because it occurs in approximately 40-50% of patients and is closely linked to progressive renal impair ment and high morbidity. [1]onventional management of LN generally relies on high-dose corticosteroids in combination with immunosuppressive agents such as cyclophosphamide (CYC), mycophenolate mofetil, and tacrolimus.However, the efficacy of these regimens is often limited by suboptimal remission rates and significant adverse effects-including gonadal toxicity, bone marrow suppression, and nephrotoxicity-which compromise their long-term use. [2]While B-cell-targeted therapies represent a promising therapeutic advance, their prohibitive cost restricts widespread access, particularly in resourcelimited settings.Therefore, given the marked clinical heterogeneity of SLE, there is a pressing need to develop optimized and individualized therapeutic strategies that balance efficacy, safety, and costeffectiveness.