LONG-TERM TREATMENT OF LUPUS NEPHRITIS WITH CYCLOSPORINE-A

We evaluated the efficacy and safety of long-term treatment with cyclo sporin A (CSA) in type IV lupus nephritis. Seventeen patients with bio psy-proven WHO type IV lupus nephritis were enrolled in a prospective, open study. Twelve of the 17 completed 48 months of treatment with CS A and prednisolone. Three patients required the addition of azathiopri ne, at 12, 38 and 47 months, respectively, for cutaneous disease flare with refractory rashes. One patient was lost to follow-up at 40 month s. The mean +/- SD duration of treatment was 43.2 +/- 10.1 months (ran ge 15.7-48 months). A significant reduction of proteinuria and a signi ficant rise in serum albumin were noted 1 month after initiation of tr eatment. Improvement was maintained throughout the study except for th ree patients who relapsed with recurrence of nephrotic syndrome. There were no significant changes in serum creatinine level or creatinine c learances throughout the study. Repeat renal biopsy at 12 months follo wing treatment with CSA showed histological improvement, with WHO type II changes in all 17 patients accompanying significant reduction in a ctivity indices. Patients with baseline haemoglobin (Hgb) levels <12 g /dl showed significant improvement. Serum C3 and C4 levels were not ch anged significantly. Corticosteroid-sparing effects were noted. Side-e ffects included hypertension, gum hypertrophy and mild hirsuitism, but were not serious. Combination therapy using CSA and prednisone is eff ective and safe for longterm treatment in lupus patients with WHO type IV nephritis.