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

Abstract

Objective:This study systemically evaluated the efficacy and safety of intermittent intravenous pulse therapy with different doses of cyclophosphamide (CTX) for the treatment of lupus nephritis (LN).Methods:We screened the Chinese Journal Full-text Database (CNKI, 1994–present), China Biology Medicine (CBMdisc, 1978–present), VIP Database for Chinese Technical Periodicals (1989–present), PubMed (1948–present), MEDLINE (Ovid SP, 1946–present), Embase (1947–present), and the Cochrane controlled trials register (13, 2017). Literature reports were selected according to the inclusion and exclusion criteria, effective data were extracted, research quality was evaluated, and RevMan5.2 was used for meta-analysis.Results:Seven randomized controlled studies were included, consisting of 655 patients. The meta-analysis results showed no significant differences between the low- and high-dose cyclophosphamide groups in partial, complete, and total remission rates as well Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Furthermore, there were no significant differences between the 2 groups in hematologic toxicity and gastrointestinal reaction, but the risk of infection (risk ratio [RR] = 0.74, 95% confidence interval [CI], 0.56–0.98, total effect inspection Z = 2.12, P = .03), and menstrual disorder (RR = 0.46, 95% CI, 0.31–0.69, total effect inspection Z = 3.83, P = .0001) decreased in the low-dose cyclophosphamide group.Conclusions: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.

Efficacy and safety of belimumab/low-dose cyclophosphamide therapy in moderate-to-severe systemic lupus erythematosus

“…This is the first retrospective study to analyze the efficacy and safety of standard-dose CYC versus Belimumab combined with low-dose CYC in the treatment of moderate to severe SLE. Although the study was not powerful enough to fully assess efficacy and was primarily designed to assess safety, the overall efficacy was consistent with those in many published literatures, and our therapy was no significant different from conventional treatment ( 4 , 10 , 16 ). The Belimumab with low-dose CYC significantly reduced the risk of infection and menstrual disorders, as well as hematological toxicity and gastrointestinal reactions compared with the standard dose.…”

“…The pathogenesis of SLE involves abnormalities of several components of the immune system, including B cells, T cells, cytokines and growth factors ( 11 , 14 ). Intermittent intravenous impulse therapy with high-dose CYC combined with glucocorticoid has been the classic treatment for moderate and severe SLE ( 16 , 30 ). While SLE patients applied CYC to induce often require high-dose and long-term treatment for disease remission.…”

“…Serious adverse events (SAEs), infusion-related AEs (an AE occurring during or within 24 hours following completion of the infusion of a study drug), and infection-related AEs were summarized independently. Infection refers to a fever occurring, and evidence of a pathogenic infection is found ( 16 , 27 – 29 ).…”

“…The treatment regimen of CYC and glucocorticoids widely acted on B and T cells and significantly increased long-term efficacy (nearly 10-year period), leading to less mortality in SLE ( 4 , 9 , 15 , 16 ). However, infection is one of the leading causes of morbidity and mortality in SLE, which has intrinsically increased risks that are expanded by immunosuppressive therapy.…”

Lupus in fabula: Hypertension of a younger man and systemic lupus erythematosus

“…Analizom efekata različitih terapijskih pristupa kod pacijenata sa proliferativnim LN utvrđeno je da tretman sa ciklofosfamidom i kortikosteroidim u kombinaciji nije efikasniji od kortikosteroida u očuvanju bubrežne funkcije ili smanjenju incidencije terminalne faze bubrežne bolesti, ali da njihova kombinacija može smanjiti stopu relapsa LN posmatrano na 48 meseci u poređenju sa samo kortikosteroidom, premda su dokazi ograničeni malom veličinom uzorka [21]. U studiji koja je sistemski procenjivala efikasnost i bezbednost intermitentne intravenozne pulsne terapije različitim dozama ciklofosfamida u lečenju LN, nije bilo očigledne razlike između grupa sa niskim i visokim dozama u efikasnosti lečenja LN, ali je rizik od infekcije značajno smanjen u grupi sa niskim dozama [22].…”