FRI0112 Intravenous pulse cyclophosphamide for lupus nephritis: predictors of remission

Abstract

Background Renal involvement in SLE is a common disease manifestation and a strong predictor of poor outcome. The general consensus is that 50% of lupus patients will develop clinically relevant nephritis at some time in the course of their illness. Cyclophosphamide is considered the most effective cytotoxic in the management of lupus renal disease. When used intravenously, cyclophosphamide is less toxic. The risk of haemorrhagic cystitis and permanent gonadal failure with infertility is greater in patients treated with oral cyclophosphamide. Long-term intravenous cyclophosphamide in combination with corticosteroids is the standard therapy for lupus nephritis. Objectives The aim of this study was to evaluate the long-term remission rates; predictors of relapse, and the ability to achieve a second remission with currently recommended regimens. Methods A cohort of 14 patients (1 male and 13 female) are enrolled into the trial. Mean age is 31.4 years (s.d = 11.9) and median time from diagnosis of SLE is 2 years. The disease severity was evaluated clinically by urinalysis, 24-hour urine protein, hematuria and casts, serum creatinine, and serum complement. We have followed up the patients for a period of 24 months, till now. Results The median time to remission was 9 months. From all patients only 4 have relapsed. 3 of them had 24 h proteinura > 3 g before treatment. Time to re-remission not evaluated yet. All patients who relapsed are still under treatment. Conclusion A high amount of proteinuria seems to be an adverse predictor of remission. The time to remission was longer in patients with high value of 24 h proteinuria. Our data suggest that a long time to remission is a predictor of earlier relapse. Prolonged courses with cyclophosphamide were needed to achieve remission in many first-treated patients. No data about the duration of treatment in patients who relapsed. No serious toxicity was observed during this study.