Cyclophosphamide and lupus nephritis: when, how, for how long?
Ever since the introduction of cyclophosphamide (CY), the management of lupus nephritis has dramatically changed, and its prognosis has greatly improved. Based on randomized controlled trials and long-term observational studies, pulse therapy with CY in combination with methyl-prednisolone (MP) is the "gold standard" of therapy for severe lupus. The realization of the significant gonadal toxicity intensified the efforts for the development of alternative immunosuppressive agents. In a large, randomized controlled trial, newer agents such as mycophenolate mofetil (MMF) have demonstrated comparable efficacy and less toxicity for moderately severe disease. To date, combinations of monthly pulses of CY with MP remain the gold standard for the induction of remission in severe lupus. For maintenance, less toxic agents such as azathioprine or MMF are equally effective and are routinely used in the current therapy of lupus.
Ntali
Stella
S
Department of Rheumatology, Clinical Immunology, and Allergy, University of Crete Medical School, Voutes, P. O. Box 2209, Heraklion, Greece.
Bertsias
George
G
Boumpas
Dimitrios T
DT
D002985:Clinical Protocols; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006058:Gonadal Disorders / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000639:trends; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction
D003520:Cyclophosphamide; D011239:Prednisolone; D009173:Mycophenolic Acid