Mejía-Vilet Juan M, Ayoub Isabelle
Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico.
Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Front Med (Lausanne). 2021 Feb 16;8:622225. doi: 10.3389/fmed.2021.622225. eCollection 2021.
Glucocorticoids therapy has greatly improved the outcome of lupus nephritis patients. Since their discovery, their adverse effects have counterbalanced their beneficial anti-inflammatory effects. Glucocorticoids exert their effects through both genomic and non-genomic pathways. Differential activation of these pathways is clinically relevant in terms of benefit and adverse effects. Ongoing aims in lupus nephritis treatment development focus on a better use of glucocorticoids combined with immunosuppressant drugs and biologics. Newer regimens aim to decrease the peak glucocorticoid dose, allow a rapid glucocorticoid tapering, and intend to control disease activity with a lower cumulative glucocorticoid exposure. In this review we discuss the mechanisms, adverse effects and recent strategies to limit glucocorticoid exposure without compromising treatment efficacy.
糖皮质激素治疗显著改善了狼疮性肾炎患者的预后。自其被发现以来，其不良反应抵消了有益的抗炎作用。糖皮质激素通过基因组和非基因组途径发挥作用。这些途径的差异激活在益处和不良反应方面具有临床相关性。狼疮性肾炎治疗发展的当前目标集中在更好地使用糖皮质激素联合免疫抑制剂和生物制剂。新的治疗方案旨在降低糖皮质激素的峰值剂量，实现糖皮质激素的快速减量，并试图以较低的糖皮质激素累积暴露量来控制疾病活动。在本综述中，我们讨论了限制糖皮质激素暴露而不影响治疗效果的机制、不良反应和最新策略。
