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Low-dose cyclosporine for active lupus nephritis: a dose titration approach

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Abstract

Objective

Achievement of complete renal remission (CR) is an important goal in lupus nephritis (LN) treatment. The use of cyclosporine (CsA) for active LN has been challenged because of variations in CsA doses and reports of adverse reactions (AR).

Method

A cohort of 62 patients with active LN (induction-resistant LN and flared LN) who were treated with CsA was evaluated. CsA was started at 50 mg/day and titrated up 25 mg/day every 2–4 weeks until CR was achieved or until treatment termination because of AR.

Results

The range of CsA dosage was 50–200 mg/day, and mean CsA dose was 102.8 ± 50.43 mg/day (1.73 ± 0.91 mg/kg/day). CsA plus mycophenolate mofetil and prednisolone was administered to 35.5% of patients, while the other 64.5% were treated with CsA and prednisolone. 90.32% had achieved CR and 4.84% had partial remission after 12 months of treatment. UPCR (urinary protein:creatinine ratio) decreased significantly in both groups (2.58 ± 3.37 to 0.36 ± 0.71 and 2.32 ± 1.45 to 0.29 ± 0.24 respectively) (P < 0.001). Non-renal activity including arthritis, alopecia, hematologic and cutaneous conditions improved in all patients. Patients whose prednisolone dose were increase received higher doses of prednisolone at baseline than patients who had stable prednisolone dose, but after 12 months the difference in dosage was insignificant (p = 0.58).

Conclusion

Patients with active LN can be effectively treated with low dose CsA, and the dose titration approach can lead to 90.32% CR with low AR rates. No difference in clinical response was observed among patients who received CsA plus prednisolone or CsA plus MMF and prednisolone.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Bangkok, 10400, Thailand

    Kittiwan Sumethkul, Tasanee Kitumnuaypong & Sungchai Angthararak

  2. Nephrology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Bangkok, 10400, Thailand

    Warangkana Pichaiwong

Authors
  1. Kittiwan Sumethkul
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  2. Tasanee Kitumnuaypong
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  3. Sungchai Angthararak
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Correspondence to Kittiwan Sumethkul.

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The study was approved by the ethics committee of the investigating hospital.

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Sumethkul, K., Kitumnuaypong, T., Angthararak, S. et al. Low-dose cyclosporine for active lupus nephritis: a dose titration approach. Clin Rheumatol 38, 2151–2159 (2019). https://doi.org/10.1007/s10067-019-04469-6

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  • DOI: https://doi.org/10.1007/s10067-019-04469-6

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