In patients with lupus nephritis, researchers compared the effectiveness of high-dose cyclophosphamide (HDCyC), low-dose cyclophosphamide (LDCyC), mycophenolate mofetil (MMF), and rituximab (LN). They compared the effectiveness of four biopsy-proven LN induction regimens: LDCyC: 500 mg biweekly, HDCyC: 750 to 1200 mg monthly, MMF: 1.5 to 3 g/d, and rituximab. In the sixth month, the outcomes of four groups were examined. There were 222 patients in total, with 26 receiving LDCyC (3-g total dosage), 113 receiving HDCyC (mean, 5.1-g total dose), 61 receiving MMF (mean, 2.2 g/d), and 22 receiving rituximab (mean, 1.9-g total dose). The number of patients with relapsing/refractory LN was 11 in HDCyC, 1 in LDCyC, 10 in MMF, and 14 in the rituximab group. Overall, 16.2 percent of those with proteinuria had no improvement, 18% had a partial reaction, and 65.8% (146/222) had a complete response. Renal response (RR) was greater in the HDCyC (90.3%) and rituximab (90.9%) groups compared to the LDCyC (73%) and MMF (72%) groups. Rituximab was shown to be useful in the treatment of relapsing illness (100% RR). The HDCyC group had the greatest rate of infection (p=0.15), followed by LDCyC and rituximab, whereas the MMF group had the highest rate of gastrointestinal side effects (p<0.001). Rituximab (OR, 20.4; 95% CI; 1.9–215.7; p=0.012), renal Baseline Systemic Lupus Erythematosus Disease Activity Index at baseline (OR, 0.86; 95% CI, 0.75–0.99; p=0.034), and disease duration (OR, 0.98; 95% CI, 0.97–0.99; p=0.009) were identified as predictors of RR.
The most successful therapy options in patients with LN, especially in the Indian context, were high-dose cyclophosphamide and rituximab. In relapsing disease, rituximab was quite beneficial.
Reference:journals.lww.com/jclinrheum/Abstract/2019/01000/Cyclophosphamide_Versus_Mycophenolate_Versus.6.aspx
