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Extended report
The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose and high-dose intravenous cyclophosphamide
  1. F A Houssiau1,
  2. C Vasconcelos2,
  3. D D’Cruz3,
  4. G D Sebastiani4,
  5. E de Ramon Garrido5,
  6. M G Danieli6,
  7. D Abramovicz7,
  8. D Blockmans8,
  9. A Cauli9,
  10. H Direskeneli10,
  11. M Galeazzi11,
  12. A Gül12,
  13. Y Levy13,
  14. P Petera14,
  15. R Popovic15,
  16. R Petrovic16,
  17. R A Sinico17,
  18. R Cattaneo18,
  19. J Font19,
  20. G Depresseux1,
  21. J-P Cosyns20,
  22. R Cervera19
  1. 1
    Rheumatology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
  2. 2
    Internal Medicine Department, Hospital Santo Antonio, Porto, Portugal
  3. 3
    The Louise Coote Lupus Unit, St Thomas’ Hospital, London, UK
  4. 4
    Rheumatology Department, Ospedale San Camillo, Roma, Italy
  5. 5
    Internal Medicine Department, Hospital regional del SAS de Malaga, Malaga, Spain
  6. 6
    Clinica Medica, Dipartimento di Scienze Mediche e Chirurigche, Universita Politecnica delle Marche, Ancona, Italy
  7. 7
    Nephrology Department, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
  8. 8
    General Internal Medicine Department, Gasthuisberg Academisch Ziekenhuis, Katholieke Universiteit Leuven, Leuven, Belgium
  9. 9
    Rheumatology Department, Università di Cagliari, Cagliari, Italy
  10. 10
    Rheumatology Department, University of Marmara Hospital, University of Marmara, Istanbul, Turkey
  11. 11
    Rheumatology Department, Università degli Studi di Siena, Siena, Italy
  12. 12
    Rheumatology Department, University of Istanbul, Istanbul, Turkey
  13. 13
    Chaim Sheba Medical Centre, Tel-Aviv University, Tel-Hashomer, Israel
  14. 14
    Rheumatology Department, Lainz Hospital, Vienna, Austria
  15. 15
    Rheumatology and Clinical Immunology Department, Military Medical Academy, Belgrade, Serbia and Montenegro
  16. 16
    Institute of Rheumatology, University of Belgrade, Belgrade, Serbia and Montenegro
  17. 17
    Clinical Immunology and Renal Unit, Ospedale San Carlo Borromeo, Milano, Italy
  18. 18
    Clinical Immunology and Allergology Department, Ospedale Civile, Università degli Studi di Brescia, Brescia, Italy
  19. 19
    Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain
  20. 20
    Pathology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
  1. Correspondence to Professor F A Houssiau, Rheumatology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, B-1200 Bruxelles, Belgium; frederic.houssiau{at}


Objective: To update the follow-up of the Euro-Lupus Nephritis Trial (ELNT), a randomised prospective trial comparing low-dose (LD) and high-dose (HD) intravenous (IV) cyclophosphamide (CY) followed by azathioprine (AZA) as treatment for proliferative lupus nephritis.

Patients and methods: Data for survival and kidney function were prospectively collected during a 10-year period for the 90 patients randomised in the ELNT, except in 6 lost to follow-up.

Results: Death, sustained doubling of serum creatinine and end-stage renal disease rates did not differ between the LD and HD group (5/44 (11%) vs 2/46 (4%), 6/44 (14%) vs 5/46 (11%) and 2/44 (5%) vs 4/46 (9%), respectively) nor did mean serum creatinine, 24 h proteinuria and damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. After 10 years of follow-up, the positive predictive value for a good outcome of an early drop in proteinuria in response to initial immunosuppressive therapy was confirmed.

Conclusion: The data confirm that a LD IVCY regimen followed by AZA—the “Euro-Lupus regimen”—achieves good clinical results in the very long term.

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  • ▸ Additional data are published online only at

  • For numbered affiliations see end of article

  • Dr J Font has died and the authors dedicate this paper to him.

  • Competing interests None.

  • Ethics approval Ethics approval from Cliniques Universitaires Saint-Luc, Université catholique de Louvain.

  • Patient consent Patient consent was received.