Treatment of diffuse proliferative lupus glomerulonephritis: A comparison of two cyclophosphamide-containing regimens

Cyclophosphamide (CYC) has proven beneficial in preserving renal function i n patients with lupus with diffuse proliferative glomerulonephritis (DPGN). However, the optimal route of CYC administration Is unknown because direct comparative studies are unavailable. In this open study, we compared the r enal outcome of two historical cohorts of patients with diffuse proliferati ve lupus nephritis (World Health Organization classes IVa and IVb) treated with either intravenous (IV) pulse CYC (group A; n = 22) or sequential oral CYC followed by azathioprine (AZA; group B; n = 21) and followed up prospe ctively. Both groups of patients had similar clinical, biochemical, and ren al parameters at baseline. At 24 months posttreatment, significant improvem ents in proteinuria, creatinine clearance, serum albumin level, and lupus s erological results were evident in both groups. Compared with patients In g roup A, patients in group B had more complete or partial remission (90% ver sus 73%) and less risk for treatment failure (5% versus 14%), renal flares (5% versus 14%), and doubling of creatinine levels (5% versus 9%), but the difference was not statistically significant. However, patients treated wit h oral immunosuppression had an Insignificant Increase in rates of herpes z oster infection (19% versus 9%) and menstrual disturbance (50% versus 29%). We conclude that sequential oral immunosuppression with CYC and AZA tended to have better efficacy than IV pulse CYC in the treatment of lupus DPGN b ut was associated with more toxicities. Additional randomized trials Involv ing a larger cohort of patients with a longer period of observation are nec essary. (C) 2001 by the National Kidney Foundation, Inc.