This house believes that low-dose intravenous cyclophosphamide is superior to standard high-dose regimes for treatment of lupus nephritis

week after the last dose of IV CYC patients were commenced on oral immunosuppression using azathioprine or cyclophosphamide. The effectiveness of the regime was demonstrated by a significant reduction in anti-double-stranded DNA (dsDNA) antibody titre and oral prednisolone dose. Only two patients developed ESRF requiring continuous peritoneal dialysis. No patients developed a significant decline in their neutrophil count 10 days after receiving low-dose IV CYC, and only one patient suffered severe sepsis. This retrospective study suggested that low-dose CYC was well tolerated and beneficial in the short term. A larger retrospective study came to essentially the same conclusion. Ninety patients with a number of different autoimmune disorders were treated with low-dose IV CYC. Of these 90 patients, 43 had lupus nephritis. Patients were treated with weekly infusions of 500 mg CYC for a median of six pulses per patient. If complete remission was achieved, patients were commenced on azathioprine; if partial remission was achieved, patients were given IV CYC 500 mg every month. Follow-up was for a median of 56 months. Results from this study revealed that 33/43 patients (75%) with lupus nephritis achieved complete or partial remission. A significant reduction of patients’ erythrocyte sedimentation rate (ESR), anti-dsDNA antibody titre and proteinuria was observed. Only 7.8% of patients had serious infections during the follow-up period. No cases of premature ovarian failure were seen in 40 pre-menopausal women [10]. The impressive safety profile of the low-dose IV CYC regime was supported in a study of 37 patients with neuropsychiatric SLE: only 5.4% of patients developed herpes zoster and no patients developed leucopenia, cystitis or amenorrhoea [11].