Cladribine in the treatment of systemic lupus erythematosus nephritis

Systemic lupus erythematosus (SLE) nephritis often requires treatment with cyclophosphamide, which carries the risk of major side eVects including infection, ovarian failure and bladder malignancy. Therapeutic strategies that would specifically target lymphocytes are appealing. Following the first report of the use of the purine nucleoside analogue cladribine (2-chloro-2’deoxyadenosine), a selective lymphocyte depleting agent, in the treatment of lupus nephritis, 1 we report our experience in two patients with severe renal involvement. CASE 1 A 32 year old woman was diagnosed with SLE at age 28, with polyarthritis, photosensitive rash, subcutaneous nodules, fatigue and lymphopenia. ANA, anti-dsDNA, anti-Sm and anti-RNP antibodies were present. Various immunosuppressants and corticosteroids failed to maintain a sustained remission. Two and a half years after presentation, she developed haematuria and proteinuria and renal biopsy revealed WHO Class III lupus nephritis. Treatment with pulsed intravenous cyclophosphamide and methylprednisolone had to be stopped after four months and a total