Petri M
Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Lupus. 2004;13(5):366-71. doi: 10.1191/0961203303lu1028oa.
Cyclophosphamide remains the 'gold standard' treatment for severe organ threatening systemic lupus erythematosus (SLE), especially renal and central nervous system lupus. Intravenous and oral cyclophosphamide have been compared, retrospectively, with similar two year remission rates of 73% and 90%. In a meta-analysis, intravenous cyclophosphamide with oral prednisone is more effective than oral prednisone alone. The efficacy of cyclophosphamide in lupus nephritis has been proven in multiple clinical trials, but efficacy has to be balanced with toxicity, including infection, gonadal failure, and malignancy. Although the continued use ofcyclophosphamide for renal lupus has been challenged by a recent trial of mycophenolate mofetil, and may be challenged in the future by planned trials of biologics, it continues to be widely used. This review will touch on the traditional intravenous 'pulse' cyclophosphamide regimen, consider its toxicity, and contrast it with newer approaches to cyclophosphamide.
环磷酰胺仍然是治疗严重威胁器官的系统性红斑狼疮（SLE），尤其是狼疮性肾炎和中枢神经系统狼疮的“金标准”疗法。回顾性比较了静脉注射和口服环磷酰胺的疗效，两年缓解率分别为73%和90%，二者相似。在一项荟萃分析中，静脉注射环磷酰胺联合口服泼尼松比单独口服泼尼松更有效。环磷酰胺治疗狼疮性肾炎的疗效已在多项临床试验中得到证实，但疗效必须与毒性相权衡，毒性包括感染、性腺功能衰竭和恶性肿瘤。尽管近期一项关于霉酚酸酯的试验对环磷酰胺持续用于治疗狼疮性肾炎提出了挑战，并且未来可能会受到生物制剂计划试验的挑战，但它仍被广泛使用。本综述将探讨传统的静脉“冲击”环磷酰胺方案，考虑其毒性，并将其与环磷酰胺的新方法进行对比。
