Treatment of diffuse proliferative lupus glomerulonephritis: A comparison of two cyclophosphamide-containing regimens

Mok, Chi Chiu; Ho, Carmen Tsz Kwan; Siu, Yui-Pong; Chan, Kwok Wah; Kwan, Tsz Hoi; Lau, Chak Sing; Wong, Rebecca; Au, Tak Cheung

doi:10.1053/ajkd.2001.26084

Cited by 94 publications

(65 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In general, improvement in proteinuria and serum creatinine is seen by 4 to 5 mo, and improvement tends to continue during the maintenance phase. Only 15% of the (10,(17)(18)(19)(20). This is higher than the complete remissions of 23% at 12 mo in this cohort; however, it is difficult to make direct comparisons among these studies because the definitions of complete and partial remission differ and sometimes were less stringent (17,18).…”

Section: Discussionmentioning

confidence: 74%

Oral Cyclophosphamide for Lupus Glomerulonephritis

McKinley

Park

Spetie

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives: In our center, systemic lupus erythematosus nephritis is routinely treated with an oral cyclophosphamide (POCY) regimen. POCY is easy to administer and less expensive than intravenous cyclophosphamide (IVCY) as it is currently used in the United States; however, the use of POCY has declined in favor of IVCY. Our experience with POCY suggests that it is well tolerated and consistently associated with good long-term outcomes. Here we report this experience to build a case for maintaining POCY as a therapeutic option in lupus nephritis.Design, setting, participants, & measurements: This is a single-center, retrospective analysis of the outcome of 46 patients who had systemic lupus erythematosus with nephritis and were treated with POCY between 1995 and 2006. POCY was given for 2 to 4 mo at a dosage of 1.0 to 1.5 mg/kg ideal body weight. After completing POCY, the patients received either azathioprine or mycophenolate mofetil.Results: Median follow-up was 23.5 mo, and median duration of POCY was 4 mo (range 1 to 16 mo). Durable complete or partial remission of proteinuria was achieved in 32 (70%) patients, whereas 5 (11%) progressed to ESRD. Outcomes were comparable in black and white individuals. Adverse effects occurred in fewer than 10% of the cohort, and only four patients discontinued POCY.Conclusions: These results suggest that sequential therapy of POCY followed by azathioprine or mycophenolate mofetil is comparable to IVCY regimens but that efficacy may not be affected by race.

show abstract

Section: Discussionmentioning

confidence: 74%

Oral Cyclophosphamide for Lupus Glomerulonephritis

McKinley

Park

Spetie

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The committee defined improved as a 50% reduction in the urinary protein: urinary creatinine ratio. The literature is replete with definitions of improvement based on the 24-hour urine protein excretion level (5,9,15,16,18,24,32,34,35,38,47,52,66,72,74,75,80,81,(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)(98). In addition, the committee thought that a reduction in proteinuria from the nephrotic range (Ն3.5 gm/day) to the non-nephrotic range was an important and distinctive end point.…”

Section: Resultsmentioning

confidence: 99%

“…There have been numerous definitions of nephrotic proteinuria (8,24,38,40,42,54,57,72,73,79,90,94,(98)(99)(100)(101); the committee chose a 24-hour urinary protein level of Ն3.5 gm. A partial response was defined as a urinary protein:urinary creatinine ratio of 0.2-2.0 (15,24,32,47,(90)(91)(92). A complete response was defined as a urinary protein:urinary creatinine ratio of Ͻ0.2 (15,24,32,35,47,52,(89)(90)(91)(92)(93).…”

Section: Resultsmentioning

confidence: 99%

“…A partial response was defined as a urinary protein:urinary creatinine ratio of 0.2-2.0 (15,24,32,47,(90)(91)(92). A complete response was defined as a urinary protein:urinary creatinine ratio of Ͻ0.2 (15,24,32,35,47,52,(89)(90)(91)(92)(93). Worsened was defined as a doubling of the urinary protein:urinary creatinine ratio (i.e., increased by 100%).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The American college of rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials

Liang

Schur

Fortin

et al. 2006

Arthritis & Rheumatism

229

View full text Add to dashboard Cite

“…From our data, the SILD regimen seems to be more efficient in reducing the positive rate of antidsDNA antibody than the HD regimen. Many studies have come up with several different regimens for remission-maintaining treatment followed by azathioprine (AZA), mycophenolate mofetil (MMF), and oral or IV CYC [5,[14][15][16]. And the MMF regimen seems to be the most effective one; however, there would be limitations in longterm using of MMF because of its high expense in developing countries.…”

Section: Discussionmentioning

confidence: 99%

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Zhang

et al. 2014

Clin Rheumatol

View full text Add to dashboard Cite

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.

show abstract

Treatment of diffuse proliferative lupus glomerulonephritis: A comparison of two cyclophosphamide-containing regimens

Cited by 94 publications

References 22 publications

Oral Cyclophosphamide for Lupus Glomerulonephritis

Oral Cyclophosphamide for Lupus Glomerulonephritis

The American college of rheumatology response criteria for proliferative and membranous renal disease in systemic lupus erythematosus clinical trials

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Contact Info

Product

Resources

About