Background/Purpose: To Compare the induction therapy of lupus nephritis with cyclophosphamide (CYC) high dose or low dose and identify possible predictors of disease remission.

Methods:  Retrospective study of patients with systemic lupus erythematosus (SLE), according to ACR criteria, diagnosed with lupus nephritis (LN), histological class III or IV, who underwent induction therapy with CYC high or low dose, respectively: CYC 0,5 to 1 g/m² body surface area monthly for six months or CYC 0,5 g every 15 days for three months. We compared the frequency of renal remission between these two groups, high dose CYC or low dose CYC, right after the induction period and after the 12 and 24 months following. Complete renal remission was defined as proteinuria less than 500 mg/24 hours. Partial remission was defined as a 50% reduction of the proteinuria starting with levels <3g. We collected clinical and laboratorial data before the induction therapy to identify possible predictors of remission.

Results:  There were 55 patients, 35 underwent high dose therapy of CYC and 20 underwent low dose therapy of CYC. There were no significant statistical differences in baseline clinical and laboratory features between these two groups. The frequency of complete renal remission right after the induction therapy was 74 % in CYC high dose group compared to 45 % in the CYC low dose group (p = 0.03). 25% of patients in the low dose group, who did not achieved remission after the 3 months of therapy, started new treatment with CYC high dose. At the end of follow-up (24 months), the frequency of remission in CYC high dose group was 86% and did not differ from the CYC low dose group (80%, p=0,21). The initial proteinuria and the serum values of complement, creatinine and albumin before the start of induction therapy, as well as the use of anti-proteinuric and antimalarial drugs have not been predictors of renal remission (p> 0.05). Table-Comparison of remission frequency between the CYC high dose group and low dose group at the end of induction therapy (after 6 and 3 months respectively)

Conclusion: The group of patients undergoing CYC high dose induction therapy achieved higher frequency of remission than the group with low dose of CYC after the induction therapy period. We did not found any predictor of renal remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-lupus-nephritis-induction-therapy-with-cyclophosphamide-high-dose-versus-low-dose/