Prospective multicentre trial on the short-term effects of plasma exchange versus cytotoxic drugs in steroid-resistant lupus nephritis
Derksen, R.H.; Hené, R.J.; Kallenberg, C.G.; Valentijn, R.M.; Kater, L.
Netherlands Journal of Medicine 33(3-4): 168-177
1988
ISSN/ISBN: 0300-2977 PMID: 3067098 Document Number: 319456
In a multicentre prospective study, we compared the effects of an additional 3-wk course of plasma exchange (PE) or cytotoxic drugs on renal function in patients with proliferative lupus nephritis who had not responded within 3 wk of high doses of prednisone (daily dose .gtoreq. 1 mg/kg body weight). During a period of 4 yr. 20 patients entered the study. After randomization, 9 patients were treated with PE and 11 with cytotoxic drugs (azathioprine in 7; cyclophosphamide in 4). At evaluation after 3 wk, 5 patients had a sufficient response. Of these, 3 patients were treated with PE and 2 with cytotoxic drugs. However, differences in the mean creatinine clearances between the two groups (at randomization 38 ml/min and 23 ml/min for the PE and cytotoxic drugs groups, respectively) may have influenced these results. None of the 6 patients with a creatinine clearance below 20 ml/min (2 in the PE group, 4 in the cytotoxic drugs group) responded to treatment. Side effects, notably infections and cytopenia, only occurred in patients with cytotoxic drugs. Except for cytopenia, all extrarenal manifestations had responded to corticosteroids alone. Our data do not indicate that cytotoxic drugs are superior to PE as an additional treatment to corticosteroids in patients with lupus nephtritis.