THERAPY OF LUPUS NEPHRITIS - A 2-YEAR PROSPECTIVE-STUDY

The aim of our study was to compare the efficacy of 3 different therap eutic protocols in the treatment of patients with WHO class IV lupus n ephritis and normal renal function. We carried out a randomized prospe ctive trial. The treatment programs consisted of a standard therapy re gimen alone (protocol A), plus plasmapheresis (protocol B) or pulse me thylprednisolone (protocol C), followed by a slow (protocols A and B) or fast (protocol C) prednisone tapering schedule. Statistical analysi s was performed, using univariate survival analysis according to Kapla n Meier and Breslow's test to compare survival curves. Eighteen patien ts entered the study: 6 protocol A, 5 protocol B and 7 protocol C. No patients developed renal insufficiency. Moreover, no statistical diffe rences in the probability of inducing partial or complete disease remi ssion and in reducing 24-hour urinary protein excretion to less-than-o r-equal-to 2 g per day were observed among the groups. Protocols A and B were more effective in comparison with protocol C in decreasing 24- hour urinary protein excretion to less-than-or-equal-to 0.5 g and less -than-or-equal-to 0.2 g per day. In conclusion, a slow prednisone tape ring schedule is more effective in reducing 24-hour urinary protein ex cretion to less-than-or-equal-to 0.5 and less-than-or-equal-to 0.1 g p er day as compared with a fast prednisone tapering schedule, even if i t is preceded by methylprednisolone pulse therapy.