Treatment of severe and difficult cases of systemic lupus erythematosus with tacrolimus. A report of three cases

Objectives-An analysis of the efficacy of tacrolimus treatment in three patients with difficult and severe systemic lupus erythematosus (SLE) whose active disease had been previously poorly controlled by cyclosporine and cyclophosphamide. Methods-A review of patient notes. Results-Two patients are well controlled after six and nine months of treatment with tacrolimus 0.06 mg/kg/day and 0.18 mg/kg/day. Previous persistent vasculitis had resolved and other features of active disease were controlled. The third patient's vasculitis had not improved significantly after two months of treatment and tacrolimus 0.17 mg/kg/day was discontinued because of nephrotoxicity. Conclusion-Tacrolimus may be a useful additional immunosuppressive agent in some patients whose SLE is not well. controlled by conventional treatments.