Controlled studies of oral immunosuppressive drugs in lupus nephritis. A long-term follow-up

S. Carette, J. H. Klippel, J. L. Decker, H. A. Austin, P. H. Plotz, A. D. Steinberg, J. E. Balow

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Abstract

From 1969 to 1975, 53 patients with lupus nephritis took part in randomized trials comparing prednisone, oral azathioprine plus low-dose prednisone, and oral cyclophosphamide plus low-dose prednisone. After a mean follow-up of 85 months, cyclophosphamide appears marginally superior to prednisone for maintaining renal function (p = 0.03) and preventing end-stage renal failure (p = 0.07). Chronic change shown by renal biopsy assessed by a chronicity index was found useful in predicting renal function outcomes and response to immunosuppressive therapy. Three of 21 patients with a low chronicity index and 9 of 10 patients with a high chronicity index doubled their serum creatinine (p <0.00003). The probability of renal functional deterioration was not different among the treatments studied. However, in 14 patients with an intermediate chronicity index, 1 of 11 patients treated with azathioprine or cyclophosphamide doubled the serum creatinine level whereas all 3 patients treated with prednisone have progressed to end-stage renal failure (p = 0.005). The study suggests that single-drug oral immunosuppressive treatment combined with prednisone is most beneficial in lupus patients with intermediate chronic change shown by renal biopsy.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalAnnals of Internal Medicine
Volume99
Issue number1
StatePublished - 1983
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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    Carette, S., Klippel, J. H., Decker, J. L., Austin, H. A., Plotz, P. H., Steinberg, A. D., & Balow, J. E. (1983). Controlled studies of oral immunosuppressive drugs in lupus nephritis. A long-term follow-up. Annals of Internal Medicine, 99(1), 1-8.