Abstract
We prospectively evaluated the efficacy and safety of a 24-month course of intermittent intravenous cyclophosphamide (IC) therapy for children suffering from lupus nephritis soon after the diagnosis of systemic lupus erythematosus (SLE) was made. Eight children with severe lupus nephritis were treated with IC monthly for 6 months and then every 3 months, totaling 24 months. The repeated measurements of sequential serological parameters of lupus nephritis, monitored over the course of the study, were analyzed statistically. The urine creatinine clearance rate (Ccr), the 24-h urine protein excretion, and the serum creatinine level significantly improved (p<0.05) after 6, 9 and 12 months of treatment, respectively. The serum C3, C4, albumin, and triglyceride level, the hemoglobin level, and the erythrocyte sedimentation rate significantly improved (p<0.05) 1 month after treatment. The IC appeared to elicit a significant effect (p<0.05) upon the mean leukocyte and neutrophil counts but had no effect (p>0.05) on the platelet count. The lymphocyte count decreased (p<0.05) during the first six monthly IC, whereas the lymphocyte count returned to the baseline level during the quarterly IC events. From a total of 96 IC doses given to those SLE patients, severe myelotoxicity occurred in one patient when lymphocyte count declined to 98 mm-3; however, no sign of clinical infection was observed. The daily steroid dosage can be tapered rapidly, and the SLE-associated hyperlipidemia resolved parallel to the resolution of the acute lupus nephritis. We concluded that the efficacy of a 24-month IC course for a child suffering from lupus nephritis is significant.
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References
Austin HA III, Klippel JH, Balow JE, leRiche NG, Steinberg AD, Plotz PH et al (1986) Therapy of lupus nephritis: controlled trial of prednisone and cytotoxic drugs. N Engl J Med 314:614–619
Steinberg AD, Steinberg SC (1991) Long-term preservation of renal function in patients with lupus nephritis receiving treatment that includes cyclophosphamide versus those treated with prednisone only. Arthritis Rheum 34(8):945–949
Boumpas DT, Austin HA III, Vaughan EM, Klippel JH, Steinberg AD, Yarboro CH et al (1992) Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 340:741–745
Gourley MF, Austin HA III, Scott D, Yarboro CH, Vaughan EM, Muir J et al (1996) Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. Ann Intern Med 125:549–557
Zonana-nacach A, Barr SG, Magder LS, Petri M (2000) Damage in systemic lupus erythematosus and its association with corticosteroids. Arthritis Rheum 43:1801–1808
Rees L, Chantler C (1990) Growth and endocrine function in children receiving long-term steroid therapy for renal disease. Acta Paediatr Scand Suppl 366:93–96
Silverman ED, Lang B (1997) An overview of the treatment of childhood SLE. Scand J Rheumatol 26:241–246
Lehman TJA (2001) Modern treatment of childhood SLE. Clin Exp Rheumatol 19:487–489
Lehman TJA, Sherry DD, Wanger-Weiner L, McCurdy DK, Emery HM, Magilavy DB, Kovalesky A (1989) Intermittent intravenous cyclophosphamide therapy for lupus nephritis. J Pediatr 114:1055–1060
Lehman TJA, Onel K (2000) Intermittent intravenous cyclophosphamide arrests progression of the renal chronicity index in childhood systemic lupus erythematosus. J Pediatr 136:243–247
Barbano G, Gusmano R, Damasio B, Alpigiani MG, Buoncompagni A, Gattorno M, Perfumo F (2002) Childhood-onset lupus nephritis: a single-center experience of pulse intravenous cyclophosphamide therapy. J Nephrol 15:123–129
Al Salloum AA (2003) Cyclophosphamide therapy for lupus nephritis: poor renal survival in Arab children. Pediatr Nephrol 18:357–361
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277
Balow JE (1990) Treatment and monitoring of patient with lupus nephritis. Nephrol Dial Transplant 5(suppl 1):S58–S59
Mc Curdy DK, Lehman TJA, Bernstein B, Hanson V, King KK, Nadorra R, Landing BH (1992) Lupus nephritis: prognostic factors in children. Pediatrics 89:240–246
Ilowite NT, Samuel P, Ginzler E, Jacobson MS (1988) Dyslipoprotenemia in pediatric systemic lupus erythematosus. Arthritis Rheum 31:859–863
Leong KH, Koh ET, Feng PH, Boey ML (1994) Lipid profiles in systemic lupus erythematosus. J Rheumatol 21:1264–1267
Bora EF, Bonfa E (1997) Dyslipoproteinemias in systemic lupus erythematosus: influence of disease, activity, and anticardiolipin antibodies. Lupus 6:533–539
Formiga F, Meco JF, Pinto X, Jacob J, Moga I, Pujol R (2001) Lipid and lipoprotein levels in premenopausal systemic lupus erythematosus patients. Lupus 10:359–363
Wallace DJ, Metzger AL, Stretcher V, Turnbull BA, Kern PA (1990) Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of corticosteroids on lipids. Am J Med 89:322–326
Martin F, Lauwerys B, Lefebvre C, Devogelaer JP, Houssiau FA (1997) Side-effects of intravenous cyclophosphamide pulse therapy. Lupus 6:254–257
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Chiu, SJ., Ou, LS., Tsai, TL. et al. Sequential evaluation of clinical and laboratory changes amongst children suffering from lupus nephritis during intermittent intravenous cyclophosphamide therapy. Clin Rheumatol 25, 515–519 (2006). https://doi.org/10.1007/s10067-005-0081-5
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DOI: https://doi.org/10.1007/s10067-005-0081-5