Pablos J L, Gutierrez-Millet V, Gomez-Reino J J
Rheumatology Department, Hospital Doce de Octubre, Madrid, Spain.
Scand J Rheumatol. 1994;23(3):142-4. doi: 10.3109/03009749409103047.
We describe the long-term follow-up of severe lupus nephritis treated with cyclophosphamide, with emphasis on the incidence of relapses after therapy withdrawal. From a cohort of SLE patients followed over a period of twelve years, we review the charts of the eleven with histologic evidence of class IV nephritis who reached complete remission with cyclophosphamide and who were followed for more than four years after the discontinuation. In all patients, cyclophosphamide was maintained for longer than two years after complete remission. Four patients relapsed following therapy withdrawal (36%). Sequential biopsies were taken in eight patients after remission or relapse and show a good histologic correlation with clinical renal data. Clinical remission with re-induction therapy could not be achieved in two patients after relapse. We conclude that relapse is frequently observed following cyclophosphamide withdrawal in lupus patients with diffuse proliferative glomerulonephritis initially responsive to this therapy. Studies are needed to determine the influence of different regimes of maintenance therapy on the rate of relapses.
我们描述了用环磷酰胺治疗重症狼疮性肾炎的长期随访情况，重点关注停药后复发的发生率。在一组随访了12年的系统性红斑狼疮（SLE）患者中，我们回顾了11例有IV级肾炎组织学证据的患者的病历，这些患者用环磷酰胺治疗后达到完全缓解，且在停药后随访了4年以上。所有患者在完全缓解后，环磷酰胺维持治疗超过两年。4例患者停药后复发（36%）。8例患者在缓解或复发后进行了连续活检，结果显示组织学与临床肾脏数据有良好的相关性。2例患者复发后再诱导治疗未能实现临床缓解。我们得出结论，在最初对环磷酰胺治疗有反应的弥漫性增殖性肾小球肾炎的狼疮患者中，停用环磷酰胺后经常观察到复发。需要开展研究以确定不同维持治疗方案对复发率的影响。
