Randomized controlled trial of pulse/synchronization cyclophosphamide/apheresis for proliferative lupus nephritis.
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.


CONCLUSIONS
The addition of pulse/synchronization apheresis to cyclophosphamide therapy does not improve the course of patients with proliferative lupus nephritis.
Wallace
D J
DJ
Department of Medicine and Pathology and Laboratory Medicine, Cedars-Sinai/UCLA School of Medicine, Los Angeles, California, USA.
Goldfinger
D
D
Pepkowitz
S H
SH
Fichman
M
M
Metzger
A L
AL
Schroeder
J O
JO
Euler
H H
HH
D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D002455:Cell Division / Q000187:drug effects; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008181:Lupus Nephritis / Q000628:therapy*
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide