Elaziz Mohamed Momtaz A, Gamal Sherif M, Fayed Ahmed, Abu-Zaid Mohammed Hassan, Ghoniem Shada A, Teleb Doaa A
Department of Internal Medicine, Nephrology Unit, Cairo University Hospital, Cairo, Egypt.
Rheumatology and Rehabilitation Department, Faculty of medicine, Cairo University Hospital, Cairo University, Al Kasr Al Aini, Old Cairo, Cairo Governorate, 4240310, Cairo, Egypt.
Z Rheumatol. 2024 Feb;83(Suppl 1):115-123. doi: 10.1007/s00393-023-01386-7. Epub 2023 Aug 15.
Lupus nephritis (LN) is a common serious presentation of systemic lupus erythematosus. Cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are listed as the first-line drugs in induction therapy for LN.
This study aimed to compare high- and low-dose CYC in a cohort of Egyptian LN patients.
The data of 547 patients with class III/IV active LN who received CYC as induction therapy were retrospectively analyzed. Whereas 399 patients received 6‑monthly 0.5-1 g/m CYC doses, 148 patients received six biweekly 500 mg CYC doses. Demographic data, laboratory test results, and disease activity index were recorded and compared at presentation and at 6, 12, 18, 24, and 48 months of follow-up.
After 48 months, the proportion of patients maintaining normal creatinine levels was higher in the group receiving induction therapy with high-dose CYC (67.9%, 60.4%, p = 0.029), and these patients also had higher proteinuria remission at 36 (26.6%, 14.8%, p = 0.014) and 48 months (24.3%, 12.8%, p = 0.006). Comparison of patient outcomes according to both induction and maintenance therapy showed the best results in patients who received high-dose CYC and continued MMF as maintenance therapy.
High- and low-dose CYC are comparable in early phases of treatment. However, after a longer duration of follow-up, high-dose CYC was associated with higher remission rates in the current cohort.
狼疮性肾炎（LN）是系统性红斑狼疮常见的严重表现形式。环磷酰胺（CYC）和霉酚酸酯（MMF）被列为LN诱导治疗的一线药物。
本研究旨在比较埃及LN患者队列中高剂量和低剂量CYC的疗效。
回顾性分析547例接受CYC诱导治疗的Ⅲ/Ⅳ级活动性LN患者的数据。其中399例患者每6个月接受0.5 - 1g/m的CYC剂量，148例患者每两周接受500mg的CYC剂量，共6次。记录患者的人口统计学数据、实验室检查结果和疾病活动指数，并在就诊时以及随访的6、12、18、24和48个月时进行比较。
48个月后，接受高剂量CYC诱导治疗的组中肌酐水平维持正常的患者比例更高（67.9%，60.4%，p = 0.029），这些患者在36个月（26.6%，14.8%，p = 0.014）和48个月（24.3%，12.8%，p = 0.006）时蛋白尿缓解率也更高。根据诱导和维持治疗对患者结局进行比较，结果显示接受高剂量CYC并继续使用MMF进行维持治疗的患者效果最佳。
高剂量和低剂量CYC在治疗早期疗效相当。然而，在更长的随访期后，高剂量CYC在当前队列中与更高的缓解率相关。
