Outcomes in Patients with Active Lupus Nephritis Requiring Immunosuppressives Who Never Received Cyclophosphamide

MURRAY B. UROWITZ, DOMINIQUE IBAÑEZ, YASER ALI, and DAFNA D. GLADMAN

ABSTRACT.

Objective. To assess outcomes in patients with lupus nephritis treated with immunosuppressives compared to those treated with cyclophosphamide in a cohort study and in a matched cohort study.

Methods. Patients with active renal disease treated with immunosuppressive/cytotoxic medications were selected from the University of Toronto Lupus Clinic database. Five outcomes were evaluated: all-cause mortality, renal failure, reversal of active renal disease, relapse of active renal disease, and toxicity.

Results. There were no differences in the outcomes of death, renal failure, reversal or relapse of active renal disease, or toxicity in those using or not using cyclophosphamide.

Conclusion. Antimetabolites should be considered standard of care for patients with lupus nephritis both for induction and for maintenance therapy. (First Release June 15 2007; J Rheumatol 2007; 34:1491-6)

Key Indexing Terms:

SYSTEMIC LUPUS ERYTHEMATOSUS
LUPUS NEPHRITIS
OUTCOMES
IMMUNOSUPPRESSIVE AGENTS
CYCLOPHOSPHAMIDE

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From the University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.

M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, Director, Centre for Prognosis Studies in the Rheumatic Diseases; D. Ibañez, MSc, Biostatistician, Centre for Prognosis Studies in the Rheumatic Diseases; Y. Ali, MD, FRCPC, Fellow in Rheumatology; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Centre for Prognosis Studies in the Rheumatic Diseases.

Address reprint requests to Dr. M. Urowitz, Toronto Western Hospital, 399 Bathurst Street, 1E-410B, Toronto, Ontario M5T 2S8. E-mail: m.urowitz@utoronto.ca

Accepted for publication April 2, 2007.

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