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Published on: November 8, 2015
[Intravenous cyclophosphamide in lupus nephritis: twenty years reducing dose]
M A Frutos1, A Martín Gómez, E de Ramón
1Nefrología, Hospital Universitario Carlos Haya. mfrutoss@senefro.org
Summary
Intermittent intravenous cyclophosphamide (IC) effectively controls lupus nephritis in systemic lupus erythematosus (SLE) patients, even with reduced doses. While generally safe, potential side effects include infections and toxicity, necessitating research into safer alternatives.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Context:
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organs, including the kidneys.
- Proliferative lupus nephritis, a severe manifestation of SLE, historically carried a poor prognosis.
- Advances in treatment have significantly improved outcomes for patients with lupus nephritis.
Purpose:
- To review the efficacy and safety of different intermittent intravenous cyclophosphamide (IC) regimens for treating proliferative lupus nephritis in SLE patients.
- To compare treatment outcomes across three distinct IC dosing strategies implemented between 1985 and the present.
- To evaluate long-term patient survival, renal function, and adverse effects associated with varying IC exposure.
Summary:
- Ninety-seven SLE patients with proliferative glomerulonephritis received varying intermittent intravenous cyclophosphamide (IC) regimens over three decades.
- All regimens demonstrated satisfactory control of lupus nephritis, with significant reductions in serum creatinine and proteinuria.
- Despite reduced IC doses in later groups, efficacy remained comparable, though infectious complications and toxicities like avascular osteonecrosis and early menopause were noted, particularly with higher cumulative doses.
Impact:
- Intermittent IC therapy offers a relatively safe and effective strategy for managing lupus nephritis in SLE patients.
- The study highlights a trend towards reduced IC dosage without compromising therapeutic outcomes, suggesting optimized treatment protocols.
- Findings underscore the need for novel therapeutic alternatives that maintain efficacy while minimizing infectious and long-term toxicities.
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