Which agents are used for maintenance therapy in lupus nephritis?

• A. Cyclophosphamide only
• B. Mycophenolate mofetil or azathioprine
• C. Rituximab monotherapy
• D. Prednisone alone

Answer: (B)

Maintenance therapy in lupus nephritis aims to sustain the remission achieved after initial treatment and prevent relapses that can harm kidney function. The preferred long-term options are mycophenolate mofetil or azathioprine because they provide ongoing immunosuppression with a favorable balance of efficacy and safety, and they help reduce the need for prolonged steroid exposure. This approach keeps the disease under control while minimizing the cumulative toxicity associated with heavy induction regimens or chronic high-dose steroids. Cyclophosphamide, while effective for induction, carries significant toxicity with cumulative exposure and is not typically used as maintenance. Rituximab can be helpful in some cases, especially refractory disease, but monotherapy is not the standard maintenance strategy in most guidelines. Prednisone alone does not reliably prevent relapses and exposes the patient to long-term steroid-related adverse effects, so it is not used as sole maintenance therapy.