ABSTRACT
Objective: A safe and effective treatment for lupus nephritis [LN]
Design: An 8-year prospective study
Setting: Hospital-based
Subjects: Three groups of patients with class IV LN; comparison of 2 new treatment-protocols for class IV LN with a retrospective group of patients who had received the standard treatment for LN
Intervention: The 2 treatment groups had received an induction phase of monthly intravenous Cyclophosphamide, Mycophenolate [MP] and Prednisone [P]. The maintenance phase in the first group was only MP and P, while patients in the second group had received only yearly Rituximab infusions
Main outcome measures: Morbidity and mortality
Results: Patients in the first group did not have significant relapses, yet had 10 episodes of infections during the maintenance phase. In the second group, there were five treatment failures, yet none had renal deterioration, infections or death. In the third group, seven relapses occurred during the induction period and three in the maintenance one. Moreover, complications included 1 death of disseminated sepsis, 12 cases of chronic renal failure, three kidney losses, 16 episodes of major infections, two cases of aseptic necrosis, two cases of gonadal failure, two cases of hemorrhagic cystitis and 2 cases of retinal deposits
Conclusions: Rituximab infusions, used once yearly, are effective and a safe maintenance therapy for most patients with LN after a short course of three anti-proliferative agents. In those who failed to respond, MP and P are more effective and safer than the standard protocol