AB0369 Evaluation of the eurolupus protocol in lupus nephritis treatment in an internal medicine department

Abstract

Background Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus since it is the major predictor of poor prognosis. Corticosteroids and immunosuppressive treatment has transformed the prognosis of this pathology despite the frequent infectious complications. The Eurolupus protocol is a new regimen using lower doses and shorter treatment durations of intravenous cyclophosphamide that have been advanced to reduce toxicity without sacrificing efficacy of therapy. Objectives Our study aims to evaluate this protocol used in patients followed in the internal medicine department of the military hospital of Tunis. Results Among 120 patients with SLE, 34 (34,16 %) had LN. Eleven (9,17%) patients were treated according to the Eurolupus protocol (6 fortnightly pulses of 500 mg; cumulative dose 3 gm, followed by azathioprine or mycophenolate monfetil “MMF”). The average age was 38 years, with 2 males and 9 females. Renal biopsy performed in 10 cases showed a LN class III, IV and IV+V in respectively 1, 7 and 2 cases. Histological signs of activity were noted in all cases with signs of chronicity in 2 cases. Maintenance therapy was azathioprine in 5 cases and MMF in 5 cases. The evolution was marked by a complete remission in 7 cases (58%), partial remission in 3 cases (27%) and deterioration of renal function in one case (9%). The average delay of remission was 5 months (1-12months). Renal relapse was noted in 4 cases (38,5%) related to treatment withdrawal, infection and/or pregnancy respectively in three, two and one cases. Infectious complications were observed in 2 cases but no cases of death have been noted. Conclusions The Eurolupus protocol leads to similar results as the old regimen of cyclophosphamide with a cumulative dose much smaller and less frequent infectious complications. References Updates on the Treatment of Lupus Nephritis. Andrew S. Bomback and Gerald B. Appel. JASN December 1, 2010vol. 21 no. 12 2028-2035 Immunosuppressive Therapy in Lupus Nephritis. The Euro-Lupus Nephritis Trial, a Randomized Trial of Low-Dose Versus High-Dose Intravenous Cyclophosphamide. Frédéric A. Houssiaud al* ARTHRITIS & RHEUMATISM, Vol. 46, No. 8, August 2002, pp 2121–2131 Disclosure of Interest None Declared

An Atypical Initial Manifestation of Systemic Lupus Erythematosus: Lupus Enteritis Accompanied by Intestinal Pseudo-Obstruction and Bilateral Hydronephroureter

“…In our patient, improvement of gastrointestinal symptoms, hydronephroureter, and cognitive function were observed. We planned to start mycophenolate mofetil after completing six fortnightly pulses of 500 mg cyclophosphamide over three months (the Euro lupus protocol of cyclophosphamide) [ 19 ].…”