Cyclosporine in the treatment of lupus nephritis including two patients treated during pregnancy.

Although the combination of corticosteroids and intermittent pulse doses of cyclophosphamide has considerably improved the prognosis of lupus nephritis, there are still some unanswered questions about this regimen, in particular its use in pregnancy. As cyclosporine appeared to be effective in experimental models of lupus nephritis, some studies have been performed using this drug in patients with lupus nephritis. However, there was no mention of pregnancy in these patients. In view of the large experience with cyclosporine during pregnancy in renal transplant recipients and its established safety concerning teratogenicity, we decided to treat 5 young female patients having lupus nephritis with cyclosporine in combination with low-dose prednisone. Two of these patients were pregnant and both had successful delivery. During the follow-up period of 7-35 months there were no signs of flare-up of the lupus nephritis, except in one case where the patient accidentally discontinued the medication. In a second patient there was a slight increase of the serum creatinine level. Otherwise, the renal and immunological parameters improved or remained stable during the observation period. Hypertension developed in 3 cases. These preliminary results support the further evaluation of cyclosporine as an alternative to cyclophosphamide in the treatment of lupus nephritis, especially in young female patients with pregnancy or at high risk for pregnancy.