Immunosuppression Withdrawal in Patients with Lupus Nephritis

What is it about?

The pathophysiology of lupus nephritis (LN) involves persistent autoimmunity represented by long-lasting immune memory. In principle, this would imply life-long immunosuppression, associated with significant toxicity. Real-world experience demonstrates that immunosuppressant withdrawal after a prolonged course of treatment is possible in more LN patients than expected; however, kidney flares develop in a significant percentage of patients, contributing to cumulative organ damage. In this perspective, we describe how to find the balance between disease activity control and treatment-related adverse effects to safely withdraw immunosuppressants in patients with LN in remission. We also provide an algorithm for slow and gradual immunosuppression withdrawal in patients in stable remission that is based on clinical, immunological, and histological data.

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