Oral cyclophosphamide for lupus glomerulonephritis: an underused therapeutic option.
OBJECTIVE
In our center, systemic lupus erythematosus nephritis is routinely treated with an oral cyclophosphamide (POCY) regimen. POCY is easy to administer and less expensive than intravenous cyclophosphamide (IVCY) as it is currently used in the United States; however, the use of POCY has declined in favor of IVCY. Our experience with POCY suggests that it is well tolerated and consistently associated with good long-term outcomes. Here we report this experience to build a case for maintaining POCY as a therapeutic option in lupus nephritis.


METHODS
This is a single-center, retrospective analysis of the outcome of 46 patients who had systemic lupus erythematosus with nephritis and were treated with POCY between 1995 and 2006. POCY was given for 2 to 4 mo at a dosage of 1.0 to 1.5 mg/kg ideal body weight. After completing POCY, the patients received either azathioprine or mycophenolate mofetil.


RESULTS
Median follow-up was 23.5 mo, and median duration of POCY was 4 mo (range 1 to 16 mo). Durable complete or partial remission of proteinuria was achieved in 32 (70%) patients, whereas 5 (11%) progressed to ESRD. Outcomes were comparable in black and white individuals. Adverse effects occurred in fewer than 10% of the cohort, and only four patients discontinued POCY.


CONCLUSIONS
These results suggest that sequential therapy of POCY followed by azathioprine or mycophenolate mofetil is comparable to IVCY regimens but that efficacy may not be affected by race.
McKinley
Alison
A
Department of Internal Medicine, Divisions of Nephrology, Ohio State University, Columbus, Ohio 43210, USA.
Park
Edward
E
Spetie
Dan
D
Hackshaw
Kevin V
KV
Nagaraja
Smitha
S
Hebert
Lee A
LA
Rovin
Brad H
BH
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000008:administration & dosage; D044383:Black People; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D011507:Proteinuria / Q000188:drug therapy / Q000208:ethnology; D012074:Remission Induction; D012189:Retrospective Studies; D044465:White People; D055815:Young Adult
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003404:Creatinine; D009173:Mycophenolic Acid; D001379:Azathioprine