This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Takada, K Articles by Boumpas, D T Search for Related Content PubMed PubMed Citation Articles by Takada, K Articles by Boumpas, D T Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CYCLOPHOSPHAMIDE Medline Plus Health Information Lupus Social Bookmarking                         What's this?

Cyclophosphamide for the treatment of systemic lupus erythematosus

G G Illei

Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA

D T Boumpas

Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA; Division of Rheumatology, Clinical Immunology and Allergy, University of Crete, Medical School, PO Box 1352, Heraklion 71110, Greece. boumpasd{at}med.uoc.gr

Aggressive immunosuppressive therapy with cyclophosphamidehas improved the outcome of major organ disease in lupus patients. Controlled trials have shown that pulse cyclophosphamide is the treatment of choice for patients with moderate to severe proliferative nephritis. Long-term follow-upof patients participating in these controlled trials suggests that combining pulse cyclophoshamide with pulse methylprednisolone increases efficacy but not toxicity.Retrospective case series have also shown that pulse cyclophosphamide therapy may be effective for the managementofsevere or refractory to standard therapy neuropsychiatric,pulmonary, cardiovascular and hematologic disease. Pulsecyclophosphamide is associated with an increased risk for herpes zoster infections in the short term and with sustained amenorrhea in the long-term. Recent studies have also drawn attention to the lack of response (or incomplete response) and flare of lupus after an initial response. In an effort to circumvent these limitations, current investigations explore the therapeutic potential of high-dose, immunoablative cyclophosphamide therapy or low-dose cyclophosphamide in combination with nucleoside analogs or biologic response modifiers.

Key Words: systemic lupus erythematosus • cyclophosphamide • remission • flare • combination therapy

Lupus, Vol. 10, No. 3, 154-161 (2001)
DOI: 10.1191/096120301671376017


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M Gayed, S Bernatsky, R Ramsey-Goldman, A. Clarke, and C Gordon Lupus and cancer Lupus, May 1, 2009; 18(6): 479 - 485. [Abstract] [PDF]

				M. K. Rafiq A unique case of systemic lupus erythematosus BMJ Case Reports, March 17, 2009; 2009(mar08_1): bcr1120081194 - bcr1120081194. [Abstract] [Full Text]

				J. M. Pego-Reigosa and D. A. Isenberg Psychosis due to systemic lupus erythematosus: characteristics and long-term outcome of this rare manifestation of the disease Rheumatology, October 1, 2008; 47(10): 1498 - 1502. [Abstract] [Full Text] [PDF]

				S Bernatsky, L Joseph, J-F Boivin, C Gordon, M Urowitz, D Gladman, P R Fortin, E Ginzler, S-C Bae, S Barr, et al. The relationship between cancer and medication exposures in systemic lupus erythaematosus: a case-cohort study Ann Rheum Dis, January 1, 2008; 67(1): 74 - 79. [Abstract] [Full Text] [PDF]

				F. Wolfe, K. Michaud, and E. F. Chakravarty Rates and predictors of herpes zoster in patients with rheumatoid arthritis and non-inflammatory musculoskeletal disorders Rheumatology, November 1, 2006; 45(11): 1370 - 1375. [Abstract] [Full Text] [PDF]

				H-H Yu, J-H Lee, L-C Wang, Y-H Yang, and B-L Chiang Neuropsychiatric manifestations in pediatric systemic lupus erythematosus: a 20-year study Lupus, October 1, 2006; 15(10): 651 - 657. [Abstract] [PDF]

				C A Pineau, S Bernatsky, M Abrahamowicz, C Neville, I Karp, and A E Clarke A comparison of damage accrual across different calendar periods in systemic lupus erythematosus patients Lupus, September 1, 2006; 15(9): 590 - 594. [Abstract] [PDF]

				R. K. Burt, A. Traynor, L. Statkute, W. G. Barr, R. Rosa, J. Schroeder, L. Verda, N. Krosnjar, K. Quigley, K. Yaung, et al. Nonmyeloablative Hematopoietic Stem Cell Transplantation for Systemic Lupus Erythematosus JAMA, February 1, 2006; 295(5): 527 - 535. [Abstract] [Full Text] [PDF]

				H Tahir and D A Isenberg Novel therapies in lupus nephritis Lupus, January 1, 2005; 14(1): 77 - 82. [Abstract] [PDF]

				S. Bernatsky, R. Ramsey-Goldman, C. Gordon, L. Joseph, J.-F. Boivin, R. Rajan, A. Allen, A. D. Moore, M.-H. Leung, and A. Clarke Factors associated with abnormal Pap results in systemic lupus erythematosus Rheumatology, November 1, 2004; 43(11): 1386 - 1389. [Abstract] [Full Text] [PDF]

				C-S Yee, C Gordon, C Dostal, P Petera, J Dadoniene, B Griffiths, B Rozman, D A Isenberg, G Sturfelt, O Nived, et al. EULAR randomised controlled trial of pulse cyclophosphamide and methylprednisolone versus continuous cyclophosphamide and prednisolone followed by azathioprine and prednisolone in lupus nephritis Ann Rheum Dis, May 1, 2004; 63(5): 525 - 529. [Abstract] [Full Text] [PDF]

				T D Myers, J R Smith, M S Wertheim, R A Egan, W T Shults, and J T Rosenbaum Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease Br J Ophthalmol, May 1, 2004; 88(5): 673 - 680. [Abstract] [Full Text] [PDF]

				T J A Lehman, B S Edelheit, and K B Onel Combined intravenous methotrexate and cyclophosphamide for refractory childhood lupus nephritis Ann Rheum Dis, March 1, 2004; 63(3): 321 - 323. [Abstract] [Full Text] [PDF]

				G Sanna, M L Bertolaccini, and A Mathieu Central nervous system lupus: a clinical approach to therapy Lupus, December 1, 2003; 12(12): 935 - 942. [Abstract] [PDF]

				M Bodani and M D Kopelman A psychiatric perspective on the therapy of psychosis in systemic lupus erythematosus Lupus, December 1, 2003; 12(12): 947 - 949. [Abstract] [PDF]

				C C Mok, R W S Wong, and K N Lai Treatment of severe proliferative lupus nephritis: the current state Ann Rheum Dis, September 1, 2003; 62(9): 799 - 804. [Abstract] [Full Text] [PDF]

				A Stallmach, B M Wittig, C Moser, J Fischinger, R Duchmann, and M Zeitz Safety and efficacy of intravenous pulse cyclophosphamide in acute steroid refractory inflammatory bowel disease Gut, March 1, 2003; 52(3): 377 - 382. [Abstract] [Full Text] [PDF]

				G. Sanni and M. A Khamashta Low-dose pulse cyclophosphamide in the treatment of neuropsychiatric lupus Lupus, January 1, 2003; 12(1): 1 - 2. [PDF]

				R. K. Burt, S. Slavin, W. H. Burns, and A. M. Marmont Induction of tolerance in autoimmune diseases by hematopoietic stem cell transplantation: getting closer to a cure? Blood, February 1, 2002; 99(3): 768 - 784. [Abstract] [Full Text] [PDF]