Background In the period 1985–1999, at the Institute of Rheumatology in Belgrade on clinical ward VI, 398 patients with SLE were treated. The most of SLE patients with major systems affected (lupus nephritis-LN, Lupus CNS and serious haematological manifestations) were treated with cyclophosphamide (Cy), some of them with “small puls”-spCy.¹ Renal function was demaged in 120 of 389 (30%) patients. Our previous experience of LN treatment with spCy was reported.²

Objectives To evaluate the effect of SLE treatment with “small puls” doses of Cy on lupus nephritis and estimation of prognostic factors for outcome of renal damage.

Methods In the follow up study the data on the effects of the treatment with spCy in 41 female patients were evaluated. “Small pulse”Cy treatment schema was established as: 400 mg Cy in iv infusion in a volume of 150 ml sol. 5% glucose during 30 min, weekly for three months, than in two or three weeks period for three months. The next treatment was once in a month during few months or years. The average age of SLE patients at the start of the disease was 27.7 yr., time from the first symptoms to the diagnose was 12.3 months and duration of the disease 9.24 yr. The kidney biopsy in 13 patients (one biopsy repeated) according to the WHO classification class revealed. Duration of treatment with spCy was 19.26 months with average total dose of 11.6 g. Short time discontinuation of the treatment was in 6 pts. Therapy was discontinuated in one pts. during serious infection.

Results The outcome of LN treatment in 28 (68.3%) patients was satisfactory (remission, mild activity of disease) and in 13 patients unsatisfactory (moderate activity in two, severe activity in three, chronic renal insufficiency in two, hemodyalisis was essential in four and two patients died). One of two patients died after self-discontinuation of SEL therapy and later development of acute renal failure during infection. The patients with unsatisfactory results were younger at the beginning of the disease; the renal damage appeared earlier during SLE. At the beginning of the therapy they had more frequently increased creatinine level and frequently hypertension. In the group with satisfactory outcome renal biopsy was more frequently performed, and therefore treatment with spCy was started earlier in LN and lasted longer

Conclusion According to our results the better prognosis in SLE patients treated with spCy was obvious if the LN was early detected using renal biopsy, if treatment started in early phase of LN and if it lasted long enough. Classic puls therapy with Cy³ should be reserved for younger patients with increased level of creatinine in early stage of LN, and with renal hypertension.

References

1. Budimir M, et al. XVIth International Congress of Rheumatology, Abstract Book Sidney, 1985;105:F74

2. Stojanovic R, et al. Clin Exp Rheumatol. 1996;14:S16–S50

3. Boumpas DT, Austin HA, Vaughn E, et al. Lancet 1992;340:741–5