Therapy of lupus nephritis. Controlled trial of prednisone and cytotoxic drugs

• Published in: The New England journal of medicine Vol. 314; no. 10; p. 614
• Main Authors: Austin, 3rd, H A, Klippel, J H, Balow, J E, le Riche, N G, Steinberg, A D, Plotz, P H, Decker, J L
• Format: Journal Article
• Language: English
• Published: United States 06-03-1986
• Subjects: Administration, Oral; Adult; Azathioprine - administration & dosage; Azathioprine - adverse effects; Azathioprine - therapeutic use; Biopsy; Clinical Trials as Topic; Creatinine - blood; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Drug Therapy, Combination; Female; Glomerulonephritis - drug therapy; Glomerulonephritis - etiology; Glomerulonephritis - physiopathology; Humans; Injections, Intravenous; Kidney - pathology; Kidney Failure, Chronic - etiology; Lupus Erythematosus, Systemic - complications; Male; Prednisone - administration & dosage; Prednisone - adverse effects; Prednisone - therapeutic use; Random Allocation
• ISSN: 0028-4793
• DOI: 10.1056/NEJM198603063141004

We evaluated renal function in 107 patients with active lupus nephritis who participated in long-term randomized therapeutic trials (median follow-up, seven years). For patients taking oral prednisone alone, the probability of renal failure began to increase substantially after five years of observation. Renal function was better preserved in patients who received various cytotoxic-drug therapies, but the difference was statistically significant only for intravenous cyclophosphamide plus low-dose prednisone as compared with high-dose prednisone alone (P = 0.027). The advantage of treatment with intravenous cyclophosphamide over oral prednisone alone was particularly apparent in the high-risk subgroup of patients who had chronic histologic changes on renal biopsy at study entry. Patients treated with intravenous cyclophosphamide have not experienced hemorrhagic cystitis, cancer, or a disproportionate number of major infections. We conclude that, as compared with high-dose oral prednisone alone, treatment of lupus glomerulonephritis with intravenous cyclophosphamide reduces the risk of end-stage renal failure with few serious complications.