Current perspectives on biomarkers to safely guide reduction and withdrawal of immunosuppressants in lupus nephritis

With new insights into damage accrual, new outcome measures and new therapies emerging, treatment for lupus nephritis (LN) has evolved over the last years. Although a greater proportion of patients shows clinical responses, treatment reduction and withdrawal remain challenging. While immunosuppressive therapy has relevant side effects, relapses pose the risk of long-term kidney function impairment. Unlike other autoimmune kidney diseases, LN lacks a unique biomarker or biomarker profile clearly reflecting disease activity. Here, we review definitions of remission, LN immunosuppressant withdrawal studies and new biomarkers correlated with disease activity. These factors can help to identify patients who can be safely withdrawn from immunosuppression reducing risk of infection, cardiovascular side effects, toxicity and damage accrual.