4 research outputs found
COMBINATION THERAPY WITH PULSE CYCLOPHOSPHAMIDE PLUS CORTICOSTEROIDS IMPROVES RENAL OUTCOME IN PATIENTS WITH LUPUS NEPHRITIS
Background: The prognosis of SLE is influenced by the onset of
glomerulonephritis. Clinical trials in lupus nephritis have
demonstrated that cyclophosphamide therapy is the superior regimen in
the management of lupus nephritis for preserving renal function.
Objective: The purpose of this study is to define the outcome of renal
function with bolus pulses of cyclophosphamide and steroid according to
our protocol and also to determine an appropriate pattern of treatment
of lupus nephritis. Methods: In this open-label clinical trial, to
evaluate the results, the short-term prognosis and the rate of
complications of an immunosuppressive regimen with corticosteroids and
cyclophosphamide, twenty-five patients with biopsy-proven lupus
nephritis were studied. Treatment was structured in 4 phases: 1)
Induction with bolus methylprednisolone and cyclophosphamide. 2)
Maintenance with oral prednisolone for 4 weeks and monthly
cyclophosphamide pulses for 6 months. 3) Tapering with reduction of
prednisolone by 10% each month and continuing cyclophosphamide every
other month till one year and for the second year every 3 months. 4)
Discontinuation with oral prednisolone slowly tapered to the least
effective daily dose and cyclophosphamide discontinued after 2 yr of
therapy. We defined primary outcome measures according to these
criteria: renal function return to normal limits or become stable,
regression of systemic and local inflammatory symptoms, urine protein
excretion falling below 0.3 gr/ dL or by at least 50%, RBC cast
disappearance, C3, C4, Hb, and ESR return to normal limits. Results:
Twenty-three patients with lupus nephritis completed our therapeutic
protocol. Renal biopsy was performed in 22 cases and indicated type IV
in 20 patients (95.2%), and type V in 2 patients. After an average of
4+1.95 months 22 patients achieved remission (95.65%) and only one case
remained non-responsive. She became pregnant in her fourth month of
therapy. Significant statistical differences were achieved between
creatinine, proteinuria, hematuria, leukocyturia, urinary cast, C3, C4,
ESR, and Hb before and after therapy (p<0.05). Plasma creatinine
fell from 1.44+0.95 mg/dL to 0.97+0.78 (p<0.004). Proteinuria fell
from 1879.78+1854.46 to 408.34+572.92 mg/24h (p<0.001). Thirteen
episode of relapses were treated again with repeated cycles of
cyclophosphamide and all remitted again. Conclusion: Intensive
immunosuppression with steroid and cyclophosphamide provides excellent
results with an acceptable rate of complications in the treatment of
lupus nephritis