Outcome of Induction Therapy with Various Regimens in Lupus Nephritis: An Observational Study

Abstract

Aim: To evaluate the outcome of induction therapy in biopsy-proven lupus nephritis and to compare the response achieved with intravenous cyclophosphamide and mycophenolate mofetil (MMF).

Materials and Methods: Fifty patients of systemic lupus erythematosus with renal involvement who underwent renal biopsy were studied over five years. Patients with Class III and Class IV nephritis received either intravenous cyclophosphamide 15 mg/kg monthly or MMF 2 g daily for six months, the choice being individualised by reproductive plans and affordability; Class V disease was treated with tacrolimus. Patients were assessed monthly with urine examination, 24-hour urinary protein and serum creatinine. Complete remission at six months was the primary end point, partial remission the secondary. Fisher's exact test was used for comparison in view of the small group sizes.

Results: Forty-six patients (92%) were female and Class IV was the commonest histological class (58%). Twenty-two patients received cyclophosphamide, 22 received MMF and six received tacrolimus. Complete and partial remission were achieved in 5 (22.7%) and 9 (40.9%) patients on cyclophosphamide and in 6 (27.3%) and 8 (36.4%) patients on MMF, an overall response of 63.6% in each group. Treatment failure occurred in 7 (31.8%) and 8 (36.4%) patients respectively. All six patients on tacrolimus responded. No statistically significant difference in six-month renal response was observed between the two treatment groups (p = 1.000).

Conclusion: No statistically significant difference in six-month renal response was observed between the cyclophosphamide and MMF groups. As treatment was not randomly allocated and the sample was small, this does not establish equivalence.

Clinical Significance: Induction therapy in this cohort was selected by reproductive plans and affordability rather than by randomisation. The outcomes describe what was achieved under those constraints.