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Short Course of Weekly Low-Dose Intravenous Pulse Cyclophosphamide in the Treatment of Lupus Nephritis: A Preliminary Study

Lupus Arthritis Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK

D.P. D'Cruz

Lupus Arthritis Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK

H.-J. Haga

Lupus Arthritis Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK

G.R.V. Hughes

Lupus Arthritis Research Unit, The Rayne Institute, St Thomas' Hospital, London, UK

We review our experience with low-dose intravenous pulse cyclophosphamide as treatment of biopsy-proven lupus nephritis. Seventeen patients were treated with 2-4 (mostly 3) weekly low-dose intravenous pulses of cyclophosphamide (500 mg) and moderate doses of prednisolone (0.5mg/kg/day), followed by an oral immunosuppressive drug (either azathioprine or cyclophosphamide). As compared with the classical monthly high-dose cyclophosphamide regimen, this weekly low-dose regimen induced neutropenia in one patient only. The incidence of herpes zoster was very low (6 %). At the end of the follow-up period (15 ± 8 months), two patients required chronic ambulatory peritoneal dialysis. The 14 patients that could be evaluated improved their mean serum albumin from 30 ± 7 to 37.5 ±7 g/l (mean ± SD; P < 0.01) and their mean serum creatinine fell from 125 ± 119 to 101 ± 66 µmol/l (not significant). Mean DNA binding dropped from 71 ± 29 to 26 ± 27 % (P < 0.001) and mean complement fraction C4 levels increased from 14 ± 8 to 28 ± 18 mg/dl (P < 0.05). The mean daily prednisolone dose was dramatically reduced from 26 ± 8 to 10 ± 4 mg (P < 0.001). Although this preliminary and retrospective study clearly needs validation with a larger cohort followed for a longer period, it seems that a treatment combining moderate doses of steroids and 3-4 weekly low-dose intravenous pulses of cyclophosphamide, followed by oral immunosuppression, is well tolerated and beneficial — at least in the short term — for most patients with severe lupus nephritis.

Key Words: Cyclophosphamide • Systemic lupus erythematosus • Lupus nephritis

Lupus, Vol. 1, No. 1, 31-35 (1991)
DOI: 10.1177/096120339100100106


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