CLINICAL EFFECTS OF INTERMITTENT, INTRAVENOUS CYCLOPHOSPHAMIDE IN SEVERE SYSTEMIC LUPUS-ERYTHEMATOSUS

To evaluate the clinical effectiveness of intermittent intravenous cyc lophosphamide in the treatment of severe systemic lupus erythematosus, 20 patients with systemic lupus erythematosus (SLE) and evidence of s evere renal involvement or systemic vasculitis, consecutively admitted to the hospital were studied. Cyclophosphamide was administered intra venously at a dosage of 1.0 g/m(2) monthly, during 6 months and mainta ined every 3 months during 12 additional months. Of 10 patients with a ctive lupus nephritis, a reduction or disappearance of proteinuria and maintenance of normal renal function was recorded in 6. Improvement o f renal function was observed in 4 out of 7 patients with renal insuff iciency at initial evaluation; resolution of renal insufficiency was m ore frequently observed in patients with recent onset renal failure. A t the end of the follow-up (18.0 +/- 14.5 months) disappearance or red uction of nephrotic range proteinuria was recorded in 6 out of 14 pati ents; there was progression toward renal failure in 4 patients (20%). Response to intravenous cyclophosphamide therapy was observed in 4 of 5 patients with severe extrarenal SLE. Side effects, recorded in 12 pa tients, were mild and transient and in no patient was the treatment di scontinued. Four patients died during the follow-up, although in 2 of them the deaths were not attributable to therapy. Even though this was an open and uncontrolled study, intermittent, intravenous cyclophosph amide was an effective therapy for severe, steroid refractory SLE.