RESEARCH - The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing low-dose versus high-dose intravenous cyclophosphamide

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Ann Rheum Dis. Published Online First: 20 January 2009.

doi:10.1136/ard.2008.102533

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Extended Report

The 10-year follow-up data of the Euro-Lupus Nephritis Trial comparing

low-dose versus high-dose intravenous cyclophosphamide

Frédéric A Houssiau 1*, Vasconcelos 2, D'Cruz 3, Gian

Domenico Sebastiani 4, Enrique de Ramon Garrido 5, Giovanna

i 6, Abramovicz 7, Blockmans 8, Alberto Cauli 9,

Haner Direskeneli 10, Mauro Galeazzi 11, Ahmet Gül 12, Yair Levy 13,

a 14, Rajko Popovic 15, Radmila Petrovic 16, Renato A

Sinico 17, o Cattaneo 18, p Font 19, Geneviève Depresseux 1,

Jean-Pierre Cosyns 1 and Ricard Cervera 19

1 Université catholique de Louvain, Belgium

2 Hospital Santo , Portugal

3 St ' Hospital, United Kingdom

4 Ospedale San Camillo, Italy

5 Hospital Regional del SAS de Malaga, Spain

6 Universita Politecnica delle Marche, Italy

7 Hôpital Erasme, Belgium

8 Gasthuisberg Academisch Ziekenhuis, Belgium

9 Universita di Cagliari, Italy

10 University of Marmara Hospital, Turkey

11 Universita degli Studi di Siena, Italy

12 University of Istanbul, Turkey

13 Chaim Sheba Medical Center, Israel

14 Lainz Hospital, Austria

15 Military Medical Academy, Serbia and Montenegro

16 University of Belgrade, Serbia and Montenegro

17 Ospedale San Carlo Borromeo, Italy

18 Universita degli Studi di Brescia, Italy

19 Hospital Clinic, Spain

Abstract

Objective: To update the follow-up of the Euro-Lupus Nephritis Trial

(ELNT), a randomized prospective trial comparing low-dose (LD) versus

high-dose (HD) intravenous (IV) cyclophosphamide (CY) followed by

azathioprine (AZA) as treatment for proliferative lupus nephritis.

Patients and methods: Data regarding survival and kidney function were

prospectively collected during a 10-year period for the 90 patients

randomized in the ELNT, except in 6 lost to follow-up.

Results: Death, sustained doubling of serum creatinine and end-stage

renal disease rates did not differ between the LD and HD group (11% vs

4%, 14% vs 11% and 5% vs 9%, respectively) nor did mean serum

creatinine, 24-h proteinuria and damage score at last follow-up. Most

patients in both groups were still treated with glucocorticoids, other

immunosuppressants and blood pressure lowering drugs. We confirm,

after 10 years of follow-up, the positive predictive value for a good

outcome of an early drop in proteinuria in response to initial

immunosuppressive therapy.

Conclusion: Our data confirm that a LD IVCY regimen followed by AZA –

the " Euro-Lupus regimen " – achieves good clinical results in the very

long-term.

http://ard.bmj.com/cgi/content/abstract/ard.2008.102533v1?papetoc

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