Oral cyclophosphamide may have advantages in severe lupus nephritis

מתוך אתר medicontext.co.il

WESTPORT, CT (Reuters Health) – Oral administration of cyclophosphamide may be superior to pulsed intravenous use of the agent in the treatment of diffuse proliferative lupus glomerulonephritis, according to Chinese researchers.

Dr. Chi Chiu Mok of Tuen Mun Hospital in Hong Kong and colleagues note that treatment of such nephritis "has to be aggressive." Dr. Mok told Reuters Health that "although cyclophosphamide has proven benefit in severe lupus nephritis, the optimal route of administration and dosage is still unclear."

In an open study, the researchers evaluated the renal outcome in 22 patients with the condition who were treated with prednisone plus monthly IV pulse cyclophosphamide and 21 patients treated with prednisone plus oral cyclophosphamide followed by azathioprine. Their findings appear in the August issue of the American Journal of Kidney Diseases.

At 24 months post-treatment, significant improvements were seen in both groups, but patients in the oral group had more complete or partial remissions (90%) than those in the IV group (73%). In addition, in the oral group there was less risk of treatment failure (5% versus 14%), renal flares (5% versus 14%) and doubling of creatinine levels (5% versus 9%).

Dr. Mok went on to say that "sequential therapy…with oral cyclophosphamide for 6 months followed by azathioprine tends to have a better efficacy than 12 intermittent intravenous pulses of cyclophosphamide, and is not associated with significantly more serious toxicities."

In light of this, he concluded that "although larger randomized controlled trials are needed, sequential oral cyclophosphamide and azathioprine may be considered as a treatment option for those patients with severe lupus nephritis and those who relapse after intermittent pulse cyclophosphamide therapy."

Am J Kidney Dis 2001;38:256-264.

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