title: Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study.
abstract: Cyclophosphamide (CYC) has long been considered a gold standard in inducing renal remission and preventing renal flares for patients with systemic lupus erythematosus (SLE). However, the rational use of CYC has not reached a consensus, such as the timing and length of treatment, the route of administration, and the ideal dosage. The objective of this study was to assess the efficacy and safety of short-interval lower-dose (SILD) intravenous (IV) CYC in the treatment of SLE. A total of 225 patients with lupus nephritis were randomly assigned to a 1-year trial, either the SILD group (12 fortnightly pulses at a fixed dose of 400 mg followed by 6 monthly pulses) or high-dose (HD) group (6 monthly pulses followed by two quarterly pulses at a dose of 0.5~1.0 g/m(2)). At 6 months of treatment, 28 % (30/107) of patients in the SILD group reached a complete remission (CR), and 51.4 % (55/107) were in partial remission (PR), as compared with 32.7 % (35/107) and 45.8 % (49/107) in the HD group, respectively. Serum albumin, 24-h urinary protein, and the scores of disease activity were significantly improved in both groups at 6 months and maintained at the end of clinical trial. However, the SILD group showed much less menstrual disturbances (11.5 %), gastrointestinal adverse effects (5.3 %), and leukopenia (9.7 %) than the HD group (28.6, 26.8, and 19.8 %, respectively) at the end of clinical trial. The efficacy of the short-interval lower-dose (SILD) IV CYC regimen in the treatment of lupus nephritis is equivalent to that of the high-dose (HD) regimen, whereas the incidence of adverse events is much lower in the SILD group.
authors.affiliation: Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Beijing, 100044, People's Republic of China.
authors.forename: X W
authors.initials: XW
authors.lastname: Zhang
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.forename: X X
authors.initials: XX
authors.lastname: Ma
authors.forename: J X
authors.initials: JX
authors.lastname: Zhao
authors.forename: Yuan
authors.initials: Y
authors.lastname: An
authors.forename: Shuang
authors.initials: S
authors.lastname: Liu
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Z G
authors.initials: ZG
authors.lastname: Li
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D003520:Cyclophosphamide / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007275:Injections, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy; D008181:Lupus Nephritis / Q000188:drug therapy; D008597:Menstrual Cycle / Q000187:drug effects; D011446:Prospective Studies; D011507:Proteinuria / Q000175:diagnosis; D012074:Remission Induction; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003520:Cyclophosphamide; D007166:Immunosuppressive Agents; D012709:Serum Albumin
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