HDCN Abstract:  ASN Annual Meeting -- San Diego  

Rovin BH, McKinley A, Park EY, et al.

Oral Cyclophosphamide (POCY) in the Management of Severe Lupus Glomerulonephritis (LN): An Under-Utilized Therapeutic Option.

ASN Annual Meeting -- San Diego
J Am Soc Nephrol (Nov) 20:406A 2009

In our center, LN patients who do not enter a clinical trial are treated with POCY for 2-4 months at a dose of 1.0-1.5 mg/kg ideal body weight. This regimen uses about half the total dose of cyclophosphamide (CY) usually reported in LN trials of POCY, and about the same amount of CY as the standard 6 month course of intravenous CY (IVCY). After completing POCY patients receive either azathioprine (AZA) or mycophenolate mofetil (MMF).

This regimen is well-tolerated and consistently associated with good long-term outcomes. POCY is easy to administer and is less expensive than IVCY as it is used in the United States. Here we report our experience with POCY in 46 SLE patients with WHO class III, IV, and V LN treated between 1995 and 2006. Median follow-up was 23.5 months. Proteinuria improved or remained stable in 90% of patients, and serum creatinine improved in 72% of patients who had renal insufficiency at the initiation of therapy. Median time to improvement was 5 months.

African Americans (AA) responded as well as European Americans (EA) to treatment. Twelve months after initiation of therapy 54% of AA and 60% of EA had achieved complete or partial remission. Age, initial serum creatinine and initial level of proteinuria were not different in patients that responded and those that did not. During follow-up only 6 patients experienced new renal flares, and only 5 patients (11%) went on to renal replacement therapy. Each patient who went to ESRD was poorly compliant with medications. Adverse events resulted in discontinuation of POCY in only 4 patients.

The main adverse events were leukopenia and gastrointestinal upset, and each occurred in less than 10% of the cohort. One patient developed amenorrhea, and no patients developed hemorrhagic cystitis. In summary POCY followed by AZA or MMF is an effective sequential treatment regimen for severe LN in both AA and EA, and has a favorable safety profile. We therefore suggest that POCY remains a relevant treatment option for LN that is easy to administer and less costly than IVCY.

© Copyright 2009-2010 American Society of Nephrology.Reproduced with permission.
Until September of 2010 all ASN abstracts from the 2009 Annual Meeting are available at this link.

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.