New and more conservative approaches in treatment are a major advance

For 30 years the US National Institutes of Health have dominated the treatment of lupus nephritis with controlled trials of monthly high dose intravenous pulse cyclophosphamide, now the standard treatment for nephritis and severe lupus. However, adverse effects such as ovarian failure and infections are significant with prolonged treatment.1 As most lupus patients are women of childbearing age, this price has been high and patients and clinicians are questioning this protocol. Recent studies offer two different approaches 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 regimen in a European study.2 3 There were similar improvements in renal variables in proliferative lupus nephritis with both regimens but with a tendency to lower toxicity in the group receiving cyclophosphamide at low dosages. This probably reflects the shorter exposure to cyclophosphamide (three …