HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.02670409v1 4/11/1754    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by McKinley, A. Articles by Rovin, B. H. PubMed PubMed Citation Articles by McKinley, A. Articles by Rovin, B. H.

Oral Cyclophosphamide for Lupus Glomerulonephritis: An Underused Therapeutic Option

Alison McKinley^*, Edward Park^*, Dan Spetie^*, Kevin V. Hackshaw, Smitha Nagaraja^*, Lee A. Hebert^*, and Brad H. Rovin^*

Department of Internal Medicine, Divisions of ^* Nephrology and Rheumatology, Ohio State University, Columbus, Ohio

Correspondence: Dr. Brad H. Rovin,Nephrology Division, Ohio State University, Ground Floor, 395 W. 12th Avenue, Columbus, OH 43210. Phone: 614-293-4997; Fax: 614-293-3073; E-mail: rovin.1{at}osu.edu

Background and objectives: In our center, systemic lupus erythematosus nephritis is routinely treated with an oral cyclophosphamide (POCY) regimen. POCY is easy to administer and less expensive than intravenous cyclophosphamide (IVCY) as it is currently used in the United States; however, the use of POCY has declined in favor of IVCY. Our experience with POCY suggests that it is well tolerated and consistently associated with good long-term outcomes. Here we report this experience to build a case for maintaining POCY as a therapeutic option in lupus nephritis.

Design, setting, participants, & measurements: This is a single-center, retrospective analysis of the outcome of 46 patients who had systemic lupus erythematosus with nephritis and were treated with POCY between 1995 and 2006. POCY was given for 2 to 4 mo at a dosage of 1.0 to 1.5 mg/kg ideal body weight. After completing POCY, the patients received either azathioprine or mycophenolate mofetil.

Results: Median follow-up was 23.5 mo, and median duration of POCY was 4 mo (range 1 to 16 mo). Durable complete or partial remission of proteinuria was achieved in 32 (70%) patients, whereas 5 (11%) progressed to ESRD. Outcomes were comparable in black and white individuals. Adverse effects occurred in fewer than 10% of the cohort, and only four patients discontinued POCY.

Conclusions: These results suggest that sequential therapy of POCY followed by azathioprine or mycophenolate mofetil is comparable to IVCY regimens but that efficacy may not be affected by race.