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Comparison between high-dose, low-dose cyclophosphamide and mycophenolate mofetil in treatment of proliferative lupus nephritis (an Egyptian multicenter retrospective study)

Background Proliferative lupus nephritis (LN) is an aggressive pathological lesion of LN. Corticosteroids, cyclophosphamide (CYC) pulse therapy either by high dose; National Institute of Health (NIH) CYC or low dose; European cyclophosphamide regimen (EURO-CYC), and mycophenolate mofetil (MMF) are the best valid lines for treatment, but the choice between them is still challenging. The objective of this study was to compare the efficacy of both CYC regimens and MMF in the treatment of proliferative LN patients. Patients and methods We retrospectively collected the data of 225 biopsy-proven proliferative LN patients (adults and juveniles) from five tertiary centers. Forty four of patients received low-dose regimen, 124 received high-dose regimen, and 57 received MMF. All demographic data, laboratory tests, activity markers, and systemic lupus disease-activity index were recorded and compared at initial presentation and at 3, 6, 12, and 24 months of follow-up. Results After 6 months of treatment, 61.2% of NIH-CYC group reached complete response, while the rate was 40.9% of EURO-CYC group and 52.7% for MMF group, and the results were in favor for the NIH group over EURO group, while there was no difference between NIH and MMF groups, but at the end of 12th, 18th, and 24th months of follow-up, the outcomes of the three groups were comparable in efficacy and safety. Conclusion For induction treatment of proliferative LN, high-dose CYC shows a better and rapid complete response after the sixth month of treatment in adults and juvenile LN patients, but after the first year of therapy, the three regimens have comparable efficacy and safety.