Cyclophosphamide and Lupus Nephritis: When, How, For How Long?

  title={Cyclophosphamide and Lupus Nephritis: When, How, For How Long?},
  author={Stella Ntali and George K. Bertsias and Dimitrios T Boumpas},
  journal={Clinical Reviews in Allergy \& Immunology},
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… 

Treatment of proliferative lupus nephritis: a slowly changing landscape

Treatment of lupus nephritis should be individually tailored to patients, with more aggressive therapy reserved for patients at high risk of renal dysfunction and progression of renal disease.

Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis

There was no obvious difference between the low and high-dose cyclophosphamide groups in efficacy in the treatment of lupus nephritis, but the risk of infection and menstrual disorder significantly decreased in the low-dose group.

THU0280 Extended Follow-Up of the Cyclofa-Lune Trial Comparing Two Sequential Induction and Maintenance Treatment Regimens for Proliferative Lupus Nephritis Based Either on Cyclophosphamide or Cyclosporine a

Rates of renal impairment and end-stage renal disease, adverse events did not differ between the CPH and CyA group, nor did mean serum creatinine, 24 h proteinuria and SLICC damage score at last follow-up.

Mechanism of Action and Efficacy of Immunosupressors in Lupus Nephritis

Mycophenolate seems to be a better choice than cyclophosphamide for induction, it is also preferred over azathioprine as a maintenance immunosuppressive agent, although azATHioprine is preferred in women with a desire for conception, those pregnant, or with low resources.

Cyclophosphamide in dermatology

The current literature on cyclophosphamide and its clinical applications in dermatology is reviewed, showing it to be useful in the treatment of severe autoimmune conditions due to its powerful immunosuppressive ability.

Extended follow-up of the CYCLOFA-LUNE trial comparing two sequential induction and maintenance treatment regimens for proliferative lupus nephritis based either on cyclophosphamide or on cyclosporine A

An immunosuppressive regimen based on CyA achieved similar clinical results to that based on CPH in the very long term, and did not differ between the CPH and CyA group.

Efficacy and safety of multi-target therapy using a combination of tacrolimus, mycophenolate mofetil and a steroid in patients with active lupus nephritis

Multi-target therapy was effective as initial treatment for active LN, with CR achieved early and in a high percentage of patients, and it is important to bear in mind the associated risk of cytomegalovirus infection.

Neuropsychiatric Systemic Lupus Erythematosus

The pathophysiology, treatment, and new potential therapies for neuropsychiatric manifestations of systemic lupus erythematosus are reviewed, including Belimumab, a human monoclonal antibody that targets B lymphocyte stimulator.

A cost-utility analysis of alternative drug regimens for newly diagnosed severe lupus nephritis patients in Thailand.

In the Thai context, the combination of i.v. CYC for the induction phase followed by AZA for the maintenance phase should be considered as the first-line therapy for newly diagnosed severe LN, as it seems to be the most cost-saving regimen.



Sequential therapies for proliferative lupus nephritis.

For patients with proliferative lupus nephritis, short-term therapy with intravenous cyclophosphamide followed by maintenance therapy with mycophenolate mofetil or azathioprine appears to be more efficacious and safer than long-term Therapy with intravenously cycloph phosphamide.

Methylprednisolone and Cyclophosphamide, Alone or in Combination, in Patients with Lupus Nephritis

The study design was modified from previous designs so that therapy could be intensified for patients with refractory or relapsing disease and some patients do not respond adequately to therapy with intermittent boluses of cyclophosphamide.

Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis.

Although most patients in both treatment groups experienced clinical improvement, the study did not meet its primary objective of showing that MMF was superior to IVC as induction treatment for lupus nephritis.

Randomized, controlled trial of prednisone, cyclophosphamide, and cyclosporine in lupus membranous nephropathy.

Patients with lupus membranous nephropathy are at substantial long-term risk for morbidity and mortality associated with protracted nephrotic syndrome, including ESRD and regimens containing CsA or IVCY are each more effective than prednisone alone in inducing remission of proteinuria among patients with LMN.

Combination Therapy with Pulse Cyclophosphamide plus Pulse Methylprednisolone Improves Long-Term Renal Outcome without Adding Toxicity in Patients with Lupus Nephritis

The results of extended follow-up and long-term effectiveness of these treatment regimens, as well as morbidity and mortality, in patients participating in this trial are reported.

Azathioprine/methylprednisolone versus cyclophosphamide in proliferative lupus nephritis. A randomized controlled trial.

In this open-label randomized controlled trial, cyclophosphamide was superior to azathioprine with regard to renal relapses and HZV and Parameters for ovarian function did not differ between the two groups.

Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis.

In this 24-week randomized, open-label, noninferiority trial, mycophenolate mofetil was more effective than intravenous cyclophosphamide in inducing remission of lupus nephritis and had a more favorable safety profile.

Treatment of diffuse proliferative lupus nephritis with prednisone and combined prednisone and cyclophosphamide.

In a four-year follow-up study, the proportion of patients alive after four years with stable or improved renal function was similar in the two treatment groups, and there was a higher incidence and average rate of clinical recurrence of nephritis in the groups initially given only steroid than in the group initially given both drugs.

Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis.

It is concluded that MMF and prednisolone constitute an effective continuous induction-maintenance treatment for DPLN in Chinese patients.

Pulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic AntibodyAssociated Vasculitis

The hypothesis that a regimen of pulsed intermittent cyclophosphamide would be as effective but less toxic than daily oral cycloph phosphamide for inducing remission in patients with generalized ANCA-associated vasculitis with active glomerulonephritis was tested.