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IMMUNE-MEDIATED KIDNEY DISEASE IN 2020

Advances in ANCA-associated vasculitis and lupus nephritis

Nature Reviews Nephrology volume 17, pages 89–90 (2021)Cite this article

Subjects

In 2020 a number of clinical trials have provided insights into therapeutic approaches for the treatment of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis and lupus nephritis. Moreover, mechanistic insights have potential to open new therapeutic strategies in the future.

Key advances

  • The addition of plasma exchange to standard of care induction therapy is not associated with improved outcomes in most patients with anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV); the use of a reduced-dose glucocorticoid regimen is non-inferior to standard dose for remission induction, but is associated with a significantly reduced risk of serious infections1.

  • Therapy with rituximab is effective in inducing remission in patients with relapsing AAV2.

  • Direct inhibition of myeloperoxidase is associated with attenuated inflammatory pathways in vitro and reduced kidney injury in a mouse model of nephrotoxin-induced nephropathy4.

  • The addition of intravenous belimumab to mycophenolate mofetil induction therapy modestly improved outcomes in a selected population with lupus nephritis5.

  • Sequential combination of rituximab followed by belimumab in lupus nephritis reduced the return of autoreactive B cells7.

  • B cell specific Toll-like receptor 9 regulates kidney disease in a mouse model of systemic lupus erythematosus and could be a therapeutic target9.

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Fig. 1: Advances in ANCA-associated vasculitis and lupus nephritis in 2020.

References

  1. Walsh, M., Merkel, P. A. & Peh, C. A. et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N. Engl. J. Med. 382, 622–631 (2020).

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Isabelle Ayoub

  2. Department of Medicine, Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA

    Patrick H. Nachman

Authors
  1. Isabelle Ayoub
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  2. Patrick H. Nachman
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Corresponding author

Correspondence to Isabelle Ayoub.

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Competing interests

P.H.N. was an investigator in the PEXIVAS and RITAZAREM trials and is a lead investigator in the Belimumab with Rituximab for Primary Membranous Nephropathy (REBOOT) trial (NCT03949855), which is sponsored by the Immune Tolerance Network. He was an investigator in trials of AAV sponsored by Chemocentryx and InflaRx, and has served as an ad hoc advisor for Chemocentryx. I.A. declares no competing interests.

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Ayoub, I., Nachman, P.H. Advances in ANCA-associated vasculitis and lupus nephritis. Nat Rev Nephrol 17, 89–90 (2021). https://doi.org/10.1038/s41581-020-00388-x

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