Abstract
Lupus nephritis (LN) is acommon serious presentation of systemic lupus erythematosus. Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are listed as the first-line drugs in induction therapy for LN. This study aimed to compare high- and low-dose CYC in acohort of Egyptian LN patients. The data of 547patients with classIII/IV active LN who received CYC as induction therapy were retrospectively analyzed. Whereas 399patients received 6‑monthly 0.5-1 g/m2 CYC doses, 148patients received six biweekly 500 mg CYC doses. Demographic data, laboratory test results, and disease activity index were recorded and compared at presentation and at 6, 12, 18, 24, and 48months of follow-up. After 48months, the proportion of patients maintaining normal creatinine levels was higher in the group receiving induction therapy with high-dose CYC (67.9%, 60.4%, p = 0.029), and these patients also had higher proteinuria remission at 36(26.6%, 14.8%, p = 0.014) and 48months (24.3%, 12.8%, p = 0.006). Comparison of patient outcomes according to both induction and maintenance therapy showed the best results in patients who received high-dose CYC and continued MMF as maintenance therapy. High- and low-dose CYC are comparable in early phases of treatment. However, after alonger duration of follow-up, high-dose CYC was associated with higher remission rates in the current cohort.
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