Tacrolimus is an effective treatment for lupus nephritis in pregnancy.

Abstract

Lupus nephritis during pregnancy increases morbidity and mortality for mother and baby. Flares are difficult to treat as many therapeutic options are teratogenic or fetotoxic. Steroids alone may be unable to control disease activity and are associated with higher rates of preterm delivery, sepsis and gestational diabetes. Reports of using tacrolimus to treat lupus nephritis in pregnancy are limited. We describe the pregnancies of nine women in whom tacrolimus was successfully used to treat lupus nephritis flare (six patients) or maintain stable disease (three patients). Introduction or dose escalation of oral steroids was avoided in five of the patients who developed active disease and steroid dose was rapidly reduced in the sixth patient. All women with disease flare attained partial or complete remission after starting tacrolimus. None of the women on maintenance treatment developed active disease. We propose tacrolimus as an effective adjuvant or alternative therapy to steroids for treating lupus nephritis flare or maintaining stable disease during pregnancy.

• Authors: P Webster, A Wardle, K Bramham, L Webster, C Nelson-Piercy, L Lightstone
• Journal: Lupus (Lupus) Vol. 23 Issue 11 Pg. 1192-6 (Oct 2014) ISSN: 1477-0962 [Electronic] England
• PMID: 24928830 (Publication Type: Case Reports, Journal Article)
• Copyright: © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Chemical References

• Immunosuppressive Agents
• Tacrolimus

Topics

• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Lupus Nephritis (drug therapy, physiopathology)
• Pregnancy
• Pregnancy Complications (drug therapy, physiopathology)
• Tacrolimus (therapeutic use)
• Treatment Outcome