McCune W J, Friedman A W
University of Michigan Medical Center, Ann Arbor.
Curr Opin Rheumatol. 1993 May;5(3):282-92. doi: 10.1097/00002281-199305030-00004.
The role of intravenous and oral cyclophosphamide in treating systemic lupus and Wegener's granulomatosis was examined in several large studies during the past year. Oral cyclophosphamide for 2 months followed by prednisone alone was relatively ineffective in preventing disease progression in lupus nephritis patients with initially abnormal serum creatinine values. A controlled trial in which three regimens for treating lupus nephritis were compared resulted in superiority of long-term intravenous cyclophosphamide therapy over pulse prednisone or short-term intravenous cyclophosphamide. Two open studies describe treatment of neuropsychiatric lupus with pulse cyclophosphamide. Patients with clinical evidence of inflammatory disease of the central nervous system appeared to respond to this therapy even if antiphospholipid antibodies were present. Analysis of a large cohort of patients with Wegener's granulomatosis showed a high incidence of cancer at long-term follow-up as well as a high incidence of recurrence, often several years after induction of remission with cyclophosphamide plus prednisone. Much progress was made in defining the mechanisms of action of cyclosporine. Additional studies examine the role of cyclosporine in necrotizing scleritis complicating rheumatoid arthritis. Concomitant administration of nonsteroidal anti-inflammatory drugs and cyclosporine to rheumatoid arthritis patients resulted in increased short-term deterioration of renal function. Studies of patients with various autoimmune diseases showed an association of the mean, maximal, and cumulative doses of cyclosporine with biopsy-proven nephropathy. Cytarabine was tried at low doses in the treatment of rheumatoid arthritis with improvement in some patients.
在过去一年的多项大型研究中，对静脉注射和口服环磷酰胺治疗系统性红斑狼疮和韦格纳肉芽肿的作用进行了研究。对于血清肌酐值最初异常的狼疮性肾炎患者，口服环磷酰胺2个月后仅使用泼尼松在预防疾病进展方面相对无效。一项比较三种治疗狼疮性肾炎方案的对照试验结果显示，长期静脉注射环磷酰胺疗法优于脉冲式泼尼松或短期静脉注射环磷酰胺。两项开放性研究描述了用脉冲环磷酰胺治疗神经精神性狼疮。即使存在抗磷脂抗体，有中枢神经系统炎症性疾病临床证据的患者似乎对这种疗法有反应。对一大群韦格纳肉芽肿患者的分析显示，长期随访时癌症发病率高，复发率也高，常在环磷酰胺加泼尼松诱导缓解数年之后。在确定环孢素的作用机制方面取得了很大进展。更多研究探讨了环孢素在类风湿关节炎并发坏死性巩膜炎中的作用。类风湿关节炎患者同时服用非甾体抗炎药和环孢素会导致肾功能短期恶化加剧。对各种自身免疫性疾病患者的研究表明，环孢素的平均剂量、最大剂量和累积剂量与经活检证实的肾病有关。低剂量阿糖胞苷试用于治疗类风湿关节炎，部分患者病情有所改善。
