The treatment of lupus nephritis

doi:10.1136/bmj.330.7488.377

BMJ 2005;330:377-378 (19 February), doi:10.1136/bmj.330.7488.377

Editorial

The treatment of lupus nephritis

New and more conservative approaches in treatment are a majoradvance

The first 150 words of the full text of this article appear below.

For 30 years the US National Institutes of Health have dominatedthe treatment of lupus nephritis with controlled trials of monthlyhigh dose intravenous pulse cyclophosphamide, now the standardtreatment for nephritis and severe lupus. However, adverse effectssuch as ovarian failure and infections are significant withprolonged treatment.¹ As most lupus patients are women of childbearingage, this price has been high and patients and clinicians arequestioning this protocol. Recent studies offer two differentapproaches that may be as effective and better tolerated.

The use of low dose cyclophosphamide, pioneered at St Thomas'Hospital, London, was recently compared with the US regimenin a European study.^2
3 There were similar improvements in renalvariables in proliferative lupus nephritis with both regimensbut with a tendency to lower toxicity in the group receivingcyclophosphamide at low dosages. This probably reflects theshorter exposure to cyclophosphamide (three months v 1 . . . [Full text of this article]

David P D'Cruz, consultant rheumatologist

Lupus Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH (david.d'cruz@kcl.ac.uk)

Graham R V Hughes, consultant rheumatologist

Lupus Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH

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