Background Cyclophosphamide is an effective treatment of lupus nephritis (LN) but have many side effects especially with high doses. Two regimens are used: monthly high dose pulses or biweekly low dose pulses (Eurolupus protocol). LN prognosis is different according to ethnicity. There are no controlled trials in African populations.
Objectives Evaluate the efficiency of two regimens of cyclophosphamide in the treatment of LN.
Patients and methods 48 patients with histological proven LN and treated with cyclophosphamide were included. Patients were divided in 2 groups: Group 1 (6 monthly high-dose intravenous cyclophosphamide) and Group 2 (Eurolupus protocol). We evaluate complete remission rate (absence of proteinuria and renal failure), partial remission (decrease of proteinuria more than 50% without renal failure) and renal relapses into the 2 groups.
Results There were 32 patients in group 1 and 16 patients in group 2. Mean age at time of LN diagnosis was 30 years in group 1 and 28.3 years in group 2. Mean level of proteinuria was 3 g/day (group 1) and 3.73 g/day (group 2). Hematuria was found in 16 and 4 patients respectively. Five patients in group 1 and three in group 2 were in renal failure at time of LN flare. Lupus nephritis was class III in 10 (group 1) and 4 cases (group 2), class IV (group 1: n=14, group 2: n=9), class III/V (group 1: n=5, group 2: n=2) and class IV/V (3 in group 1). Complete remission was achieved in 62.5% of case in group 1% and 56.3% patients in group 2 (p=0.6). Partial remission was obtained in 25% of cases in both groups. Renal relapses occurred in 12.5% (group1) and 18.8% (group 2) of patients (p=0.56). None had end stage renal failure. The average duration of follow up was of 5.32 years in the group 1 and 5.49 years in group 2.
Conclusion Monthly cyclophosphamide pulses regimen was similar to Eurolupus protocol in our group. These results encourage us to use biweekly cyclophosphamide pulses which are safer in SLE patients. More studies are needed to confirm these results.
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