Background and Aims The current therapeutic strategy for childhood-onset lupus nephritis (LN) involves an induction phase, aiming to promote remission, and a maintenance phase control disease and prevent relapses. Various regimens have been used worldwide, which differ in drug of choice and dosage, and duration of the induction and maintenance phases. This study evaluated treatment outcome and adverse event occurrence in Filipinos with childhood-onset LN.
Methods Medical records of patients diagnosed with childhood-onset LN who received an extended induction phase of 9 months followed by a maintenance phase of 5 quarterly intravenous cyclophosphamide pulses from year 2006 to 2014 at the University of Santo Tomas Hospital were reviewed.
Results Nineteen patients completed the modified regimen (94.7% female, mean age 11.2+3.7 years at lupus diagnosis, mean LN duration to completion of treatment 30.6+5.2 months). At 9 months, 47.4% (9/19) reached complete remission, and 52.6% (10/9) were in partial remission. After 9 monthly and 5 quarterly pulses, 94.7% (18/19) was with complete treatment response. One patient relapsed during the maintenance phase and was with partial response at the end of treatment. The random urine protein:creatinine ratio and disease activity were significantly improved in all 19 patients. Treatment failure was not noted in any of the patients at the end of maintenance phase and at completion. Reported adverse events were gastrointestinal symptoms (100%), mild infections (94.7%), alopecia (89.5%), severe infections (10.5%), menstrual irregularities (33.3%), and hematologic disturbances (26.3%).
Conclusions A modified regimen of 9 monthly and 5 quarterly cyclophosphamide pulses may be an effective therapeutic option for childhood-onset LN.
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