Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide

To assess outcomes in patients with lupus nephritis treated with immunosuppressives compared to those treated with cyclophosphamide in a cohort study and in a matched cohort study.

Patients with active renal disease treated with immunosuppressive/cytotoxic medications were selected from the University of Toronto Lupus Clinic database. Five outcomes were evaluated: all-cause mortality, renal failure, reversal of active renal disease, relapse of active renal disease, and toxicity.

There were no differences in the outcomes of death, renal failure, reversal or relapse of active renal disease, or toxicity in those using or not using cyclophosphamide.

Antimetabolites should be considered standard of care for patients with lupus nephritis both for induction and for maintenance therapy.