Abstract
BackgroundThe current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months.MethodsWe carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death.ResultsTwenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection.ConclusionsFor induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.
Highlights
The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC)
We present our experience with 41 Nepalese patients with lupus nephritis and demonstrate that this dosing is clinically effective in our population
All the patients were positive for antinuclear antibody (ANA), while anti ds-DNA antibody was positive in 87.8 % of them
Summary
The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. LN affects the clinical outcomes both directly by target organ damage and indirectly through complications of therapy [1]. It is a major cause of end stage renal disease (ESRD) and is associated with a greater than four-fold increase in mortality [1, 5]. The NIH trials used IVC at 0.5–1 g/m2 monthly for 6 months while the Euro-Lupus Nephritis trial used IVC 500 mg every 2 weeks for 3 months, lowering the dose and duration of IVC without sacrificing the efficacy [11, 13]
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