TREATMENT OF SYSTEMIC LUPUS-ERYTHEMATOSUS WITH INTRAVENOUS CYCLOPHOSPHAMIDE - INTEREST AND LIMITS

Monthly intravenous cyclophosphamide (IVCY) has been a recommended the rapy for severe lupus nephritis or neurological flareups in lupus pati ents. But the optimal treatment regimen and duration remains unknown. We report our experience in an open study of 37 patients treated with monthly IVCY. Thirty-four women and 3 men, mean age 35.5 with a mean d isease duration of 59 months, with a mean 5.7 ACR criteria for SLE wer e analysed. 27 (group I) had lupus nephritis (OMS Class III or IV) and 10 had neurological involvement (group II). In group I, after six mon ths of IVCY, a significant improvement was noticed in the UCH-Middlese x clinical index (2.9 pts vs 7.8), the proteinuria (3.12 g/d vs 5.4), complement and split fractions (CH50 98.4 vs 48.9 % ; C3 877 vs 600 mg /l ; C4 177 vs 128 mg/1), the level of anti-DNA antibodies (67.5 vs 77 5 UI/ml) and the daily dose of steroids (22 vs 44 mg/d). Kidney biopsi es showed a reduction of the activity index despite a slight increase of the chronicity index (4.1 vs 6.3 pts and 5.5 vs 3.6 pts). Those res ults were not maintained at medium and long term. Moreover five patien ts presented with worsening of renal function during IVCY treatment an d two patients relapsed after the end of the treatment. In group II si gnificant improvement was noticed at six months concerning the clinica l index (1.77 pts vs 7.17) and the daily dose of steroids, 3 patients died because of cerebral vasculitis refractory to IVCY. Adverse effect s are frequent : infectious (25 among 20 patients), hemorragic cystiti s (2 events in 1 patient), gastrointestinal side effects were common ( 12/37 patients). Were also noticed : neutropenia (5/37), transient ame norrhea (4/28), drug induced menopausis (2/28). Overall mortality is i mportant (7/37), uneffectiveness of IVCY was noticed in 5 patients, fl ares occured in 8 patient during or after stopping treatment. IVCY see ms efficacious if given at the very begining of the flare. Its usefull ness is obvious at six months among clinical and biological data in pa tients with severe lupus nephritis or neurological flare. It seems tha t long term outcome on the renal function is not modified.