{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T06:07:58Z","timestamp":1779084478382,"version":"3.51.4"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002858","name":"China Postdoctoral Science Foundation","doi-asserted-by":"publisher","award":["2025M773983"],"award-info":[{"award-number":["2025M773983"]}],"id":[{"id":"10.13039\/501100002858","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82174382"],"award-info":[{"award-number":["82174382"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Lupus nephritis (LN) remains a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE). Although recent years have witnessed the approval of several targeted therapies, achieving long-term, drug-free remission remains challenging. This commentary evaluates the global landscape of interventional LN clinical trials from 2001 to 2026 to identify emerging trends and strategic gaps in drug development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We analyzed 200 interventional pharmacological trials retrieved from three major global registries:\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      ,\n                      <jats:ext-link>Chinadrugtrials.org<\/jats:ext-link>\n                      , and ISRCTN. Trials were systematically categorized by study phase, geographic distribution, and therapeutic mechanism, with data synthesized to reflect the transition from non-specific immunosuppression to precision-targeted approaches.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings<\/jats:title>\n                    <jats:p>Our analysis indicates an accelerating trend in Phase II\/III trials, with a notable geographic shift toward the Asia-Pacific region. We identify a diversification of therapeutic targets beyond B-cell depletion (e.g., obinutuzumab) to include complement inhibitors, intracellular signaling blockers (BTK and JAK inhibitors), and novel immune-reset strategies such as CAR-T therapy. Despite these innovations, complete renal response rates in pivotal trials often plateau at 40-50%, suggesting a persistent \u201cceiling effect\u201d.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and implications<\/jats:title>\n                    <jats:p>To break current therapeutic plateaus, future research must prioritize: (1) integrating pharmacogenomics (e.g., CYP3A5 and TPMT genotyping) for personalized drug selection; (2) developing steroid-fast-tapering or steroid-free induction protocols to minimize toxicity; and (3) validating real-time molecular biomarkers to replace lagging clinical indicators. This data-driven perspective provides a practical framework for refining trial designs and achieving precision medicine in LN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1762892","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T05:43:30Z","timestamp":1779083010000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Global perspectives on lupus nephritis: a review of clinical trials and therapeutic innovations"],"prefix":"10.3389","volume":"17","author":[{"given":"Jiaruo","family":"Xu","sequence":"first","affiliation":[{"name":"Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongkang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Innovation Research Institute of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]},{"name":"Diagnosis & Treatment Center of Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"Laboratory Animal Center of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yemin","family":"Cao","sequence":"additional","affiliation":[{"name":"Diagnosis & Treatment Center of Vascular Disease, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, 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