THERAPY OF PROLIFERATIVE LUPUS GLOMERULONEPHRITIS - A PROSPECTIVE TRIAL IN THE NETHERLANDS

Proliferative glomerulonephritis is a severe clinical manifestation of systemic lupus erythematosus, and it remains a major determinant of m orbidity and mortality in this disease, despite the progress that has been made by treating patients with a combination of corticosteroids a nd cytotoxic drugs. Earlier controlled clinical trials have demonstrat ed the superior efficacy of a combination of pulse cyclophosphamide wi th steroids over treatment with steroids alone. However, cyclophospham ide carries a substantial risk of short-term and long-term toxicity in this predominantly young population, and previous trials have not con vincingly shown any benefit over the milder treatment with a combinati on of azathioprine and steroids. We propose to conduct a Dutch multice ntre trial to test whether similar renal survival can be achieved with an azathioprine-based regimen, compared to the widely used cyclophosp hamide treatment, with a possibly lower risk of adverse effects.