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NDT Advance Access originally published online on December 4, 2008
Nephrology Dialysis Transplantation 2009 24(2):381-384; doi:10.1093/ndt/gfn640
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


How did cyclophosphamide become the drug of choice for lupus nephritis?

Joanne M. Bargman1,2

1 Renal-Rheumatology Lupus Clinic, University Health Network 2 University of Toronto, Toronto, Ontario, Canada

Correspondence and offprint requests to: Joanne M. Bargman, Toronto General Hospital, 200 Elizabeth Street, 8N-840, Toronto, Ontario, Canada M5G 2C4. Tel: +(1) 416340-4804; Fax: +(1) 416340-4999; E-mail: joanne.bargman@uhn.on.ca

Keywords: azathioprine; cyclophosphamide; lupus; lupus nephritis; outcomes

The first 150 words of the full text of this article appear below.



   Lessons learned from the early studies of corticosteroids and other agents
 
Thirty years ago, Donadio and colleagues published the results of a randomized study in 50 patients with diffuse proliferative lupus nephritis and reduced creatinine clearance [1]. The patients were randomly assigned to either prednisone alone or prednisone in combination with oral cyclophosphamide (CTX). The corticosteroid-only group received 60 mg daily for 1 to 3 months, and then tapered to receive 20 mg daily by 6 months. Those in the second group received, in addition, oral CTX 2 mg/kg body weight, which was subsequently titrated to the peripheral white cell count. The majority of patients in both groups improved with therapy. The patients who quickly progressed to ESRD were equally divided between the two treatment regimens. It was in the long-term follow-up that the CTX group appeared to do better: after a mean of 43 months, 10 of 21 patients in the prednisone-only group relapsed, compared to 3 of . . . [Full Text of this Article]



   The NIH Publication and the popularization of pulse CTX
 


   Is azathioprine the hydrochlorothiazide of lupus therapy?
 


   The best thing about MMF is that it will convince people that there are therapies for lupus nephritis other than pulse CTX
 


   Is the problem with CTX itself, or are we using too high a dose?
 


   Conclusions
 

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J. M. Bargman
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Nephrol. Dial. Transplant., August 1, 2009; 24(8): 2612 - 2612.
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