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Controlled Studies of Oral Immunosuppressive Drugs in Lupus Nephritis: A Long-Term Follow-Up

SIMON CARETTE, M.D.; JOHN H. KLIPPEL, M.D.; JOHN L. DECKER, M.D.; HOWARD A. AUSTIN, M.D.; PAUL H. PLOTZ, M.D.; ALFRED D. STEINBERG, M.D.; and JAMES E. BALOW, M.D.
[+] Article and Author Information

Grant support: Dr. Carette is a fellow of the Canadian Arthritis Society.

Presented in part June 1982 at the VIII Pan-American Congress of Rheumatology, Washington, D.C. Published in abstract form in Arthritis Rheum. 1982;25:S68.

▸Requests for reprints should be addressed to John H. Klippel, M.D.; Building 10, Room 9N240, National Institutes of Health; Bethesda, MD 20205.


Bethesda, Maryland


Ann Intern Med. 1983;99(1):1-8. doi:10.7326/0003-4819-99-1-1
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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.

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