Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis.
No previous study has compared mycophenolate mofetil (MMF) with low-dose cyclophosphamide (CYC) in the treatment of lupus nephritis (LN). To do so, we recruited patients with LN (class III, IV, or V) and randomized them to receive either low-dose CYC or oral MMF. Those with crescentic LN, a serum creatinine over 265 μmol/l, and neurological or pulmonary lupus were excluded. MMF was prescribed at daily doses of 1.5-3 g for 24 weeks, while CYC was administered as six fortnightly infusions of 500 mg each. All patients received three methylprednisolone injections, followed by oral corticosteroids. Maintenance therapy with azathioprine and low-dose corticosteroid was started at end of induction therapy. The primary end point was treatment response at 24 weeks, while secondary end points were complete remission, Systemic Lupus Erythematosus Disease Activity Index and adverse events. Of the 173 patients recruited, 100 were equally randomized to receive either CYC or MMF. Baseline characteristics were similar, except for higher 24 h proteinuria in the CYC group. At 24 weeks, 37 patients in each group achieved the primary end point. The complete remission rate was 50% in CYC and 54% in MMF group. Gastrointestinal symptoms were significantly more frequent in patients receiving MMF (52 vs. 4%). However, other adverse events were similar. Thus, low-dose intravenous CYC is comparable in safety and efficacy to oral MMF in the induction treatment of less severe LN.
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: drmanishrathi2000@yahoo.co.in.
Manish
M
Rathi
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ajay
A
Goyal
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ajay
A
Jaryal
Department of Internal Medicine, Rheumatology Wing, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Aman
A
Sharma
Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Pramod K
PK
Gupta
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Raja
R
Ramachandran
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Vivek
V
Kumar
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Harbir S
HS
Kohli
Department of Nephrology and Renal Transplant Surgery, Max Super Speciality Hospital, Mohali, India.
Vinay
V
Sakhuja
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Vivekanand
V
Jha
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Krishan L
KL
Gupta
D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016527:Drug Costs; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*; D008181:Lupus Nephritis / Q000188:drug therapy*; D060046:Maintenance Chemotherapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine; D008775:Methylprednisolone
cyclophosphamide; lupus nephritis; mycophenolate mofetil