Clinical Reviews in Allergy & Immunology

, Volume 40, Issue 3, pp 181–191

Cyclophosphamide and Lupus Nephritis: When, How, For How Long?

  • Stella Ntali
  • George Bertsias
  • Dimitrios T. Boumpas
Article

DOI: 10.1007/s12016-009-8196-0

Cite this article as:
Ntali, S., Bertsias, G. & Boumpas, D.T. Clinic Rev Allerg Immunol (2011) 40: 181. doi:10.1007/s12016-009-8196-0

Abstract

Ever since the introduction of cyclophosphamide (CY), the management of lupus nephritis has dramatically changed, and its prognosis has greatly improved. Based on randomized controlled trials and long-term observational studies, pulse therapy with CY in combination with methyl-prednisolone (MP) is the “gold standard” of therapy for severe lupus. The realization of the significant gonadal toxicity intensified the efforts for the development of alternative immunosuppressive agents. In a large, randomized controlled trial, newer agents such as mycophenolate mofetil (MMF) have demonstrated comparable efficacy and less toxicity for moderately severe disease. To date, combinations of monthly pulses of CY with MP remain the gold standard for the induction of remission in severe lupus. For maintenance, less toxic agents such as azathioprine or MMF are equally effective and are routinely used in the current therapy of lupus.

Keywords

Induction therapyMaintenance therapyLupus nephritisRandomized controlled trials

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Stella Ntali
    • 1
  • George Bertsias
    • 2
  • Dimitrios T. Boumpas
    • 1
    • 2
  1. 1.Department of Rheumatology, Clinical Immunology, and AllergyUniversity of Crete Medical SchoolHeraklionGreece
  2. 2.Department of Internal MedicineUniversity of Crete School of MedicineHeraklionGreece