Department of Rheumatology, Clinical Immunology, and Allergy, University of Crete Medical School, Voutes, P. O. Box 2209, Heraklion, Greece.
Clin Rev Allergy Immunol. 2011 Jun;40(3):181-91. doi: 10.1007/s12016-009-8196-0.
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.
自从环磷酰胺（CY）问世以来，狼疮肾炎的治疗发生了巨大变化，其预后也得到了极大改善。基于随机对照试验和长期观察性研究，CY 联合甲泼尼龙（MP）脉冲疗法是治疗重症狼疮的“金标准”。性腺毒性的显著认识促使人们努力开发替代免疫抑制剂。在一项大型随机对照试验中，新型药物如霉酚酸酯（MMF）在中度严重疾病中显示出相当的疗效和较少的毒性。迄今为止，CY 联合 MP 的每月脉冲治疗仍然是严重狼疮诱导缓解的金标准。对于维持治疗，毒性较小的药物如硫唑嘌呤或 MMF 同样有效，并且在目前的狼疮治疗中常规使用。
