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New synchronized therapy with plasmapheresis and high-dose cyclophosphamide in severe systemic lupus erythematosus

The aim of this study was to compare the outcomes of plasmapheresis (PP) in patients with severe lupus treated with cyclophosphamide (Cyc) boluses. The study analysis involved 30 patients. In group I, 15 patients were treated with synchronized therapy (PP, 60 ml/kg, followed by pulse Cyc, 750 mg/m/sup 2/, repeated monthly for 6 months), whereas in group II, 15 patients were given only intermittent Cyc boluses (at the same dosage). Patients were followed-up for a mean of 5 years. At the end of the 6-month treatment period, a statistically significant number patients in group I (80%) was in complete remission in comparison to group II (40%) (P< 0.02), whereas at long-term follow-up, these percentages were similar {40% vs. 53%, P = n.s.). The main functional and immunological parameters showed a normalization in both groups. We documented a higher rate of infectious complications in group I. This study reports that synchronized therapy is useful in inducing a faster remission in patients with severe lupus. However, it is not superior to conventional therapy at long-term follow-up analysis. Positive results should be reinforced by long-term maintenance therapy.