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Randomized controlled trial of pulse/synchronization cyclophosphamide/apheresis for proliferative lupus nephritis
D J Wallace1, D Goldfinger, S H Pepkowitz
1Department of Medicine and Pathology and Laboratory Medicine, Cedars-Sinai/UCLA School of Medicine, Los Angeles, California, USA.
Insights
Adding apheresis to cyclophosphamide therapy did not improve outcomes for patients with proliferative lupus nephritis. Neither treatment group showed significant differences in renal remission or end-stage renal disease rates.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- Proliferative lupus nephritis is a severe manifestation of systemic lupus erythematosus.
- Treatment strategies aim to prevent kidney damage and preserve renal function.
Purpose of the Study:
- To evaluate the effectiveness of adding pulse/synchronization apheresis to cyclophosphamide therapy.
- To assess the impact on clinical and laboratory markers in proliferative lupus nephritis.
Main Methods:
- Prospective randomized trial involving 18 patients with lupus nephritis (Class III/IV).
- Patients received cyclophosphamide with prednisone; one group additionally received daily plasmapheresis.
- Outcomes assessed at 6 and 24 months included serum creatinine, urine protein, and immunological markers.
Main Results:
- No significant difference in end-stage renal disease or renal remission rates between groups.
- Both groups showed improvements in serum albumin, C3 complement, and SLAM scores.
- Anti-DNA antibody levels improved significantly in the pulse/synchronization apheresis group.
Conclusions:
- Pulse/synchronization apheresis combined with cyclophosphamide does not enhance treatment outcomes for proliferative lupus nephritis.
- Further research may be needed to identify optimal therapeutic approaches for this condition.
Objective:
To assess the efficacy of pulse/synchronization cyclophosphamide/apheresis in patients with proliferative lupus nephritis.
Methods:
Eighteen patients with Class III or IV renal biopsies and chronicity indices <6 were prospectively randomized to receive 6 courses of parenteral cyclophosphamide over 8 months along with prednisone. Nine of these patients also received 3 daily plasmaphereses prior to each of the 6 courses of cyclophosphamide. Assessments compiled at 6 and 24 months included serum creatinine, albumin, anti DNA, 24-hour urine protein, and C3 complement along with SLAM scores.
Results:
Two out of nine patients in each group evolved end stage renal disease and 3/9 patients in each group went into a renal remission at 24 months. Serum albumin, C3 complement, and SLAM scores improved in both groups, and anti-DNA improved in the pulse/synchronization patients (P < 0.025). No intergroup comparisons were significant.
Conclusion:
The addition of pulse/synchronization apheresis to cyclophosphamide therapy does not improve the course of patients with proliferative lupus nephritis.
