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Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis
Abstract
Pulse cyclophosphamide is more effective than prednisone alone in preventing renal failure in lupus nephritis. We undertook a randomised, controlled trial to find out whether pulse methylprednisolone could equal pulse cyclophosphamide in preserving renal function in patients with lupus nephritis, and whether there was a difference between long and short courses of pulse cyclophosphamide in preventing exacerbations. 65 patients (60 female, 5 male; median [range] age 29 [10-48] years) with severe lupus nephritis were assigned randomly to monthly pulse methylprednisolone for 6 months (25 patients), monthly pulse cyclophosphamide for 6 months (20), or monthly cyclophosphamide for 6 months followed by quarterly pulse cyclophosphamide for 2 additional years (20). Patients treated with pulse methylprednisolone had a higher probability of doubling serum creatinine than those treated with long-course cyclophosphamide (p less than 0.04). Risk of doubling creatinine was not significantly different between short and long course cyclophosphamide. However, patients treated with short-course cyclophosphamide had a higher probability of exacerbations than those treated with long-course cyclophosphamide (p less than 0.01). An extended course of pulse cyclophosphamide is more effective than 6 months of pulse methylprednisolone in preserving renal function in patients with severe lupus nephritis. Addition of a quarterly maintenance regimen to monthly pulse cyclophosphamide reduces the rate of exacerbations.
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Cited by
Mycophenolate Mofetil versus Cyclophosphamide for Induction Treatment of Lupus Nephritis
Appel, G. B., Contreras, G., Dooley, M. A., Ginzler, E. M., Isenberg, D., Jayne, D., Li, L.-S., Mysler, E., Sa[Combining Acute Accent]nchez-Guerrero, J., Solomons, N., et al. (2009) · Journal of the American Society of Nephrology · doi:10.1681/asn.2008101028 · Cited by 1,118
Houssiau, F. A., Vasconcelos, C., D'Cruz, D., Sebastiani, G. D., Garrido, E. D. R., Danieli, M. G., Abramovicz, D., Blockmans, D., Mathieu, A., Direskeneli, H., et al. (2002) · Arthritis & Rheumatism · doi:10.1002/art.10461 · Cited by 1,077
Sequential Therapies for Proliferative Lupus Nephritis
Contreras, G., Pardo, V., Leclercq, B., Lenz, O., Tozman, E., O'Nan, P., & Roth, D. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa031855 · Cited by 818
Bertsias, G., Ioannidis, J. P. A., Boletis, J., Bombardieri, S., Cervera, R., Dostal, C., Font, J., Gilboe, I. M., Houssiau, F., Huizinga, T., et al. (2008) · Annals of the Rheumatic Diseases · doi:10.1136/ard.2007.070367 · Cited by 762
Gourley, M. F., Austin III, H. A., Scott, D., Yarboro, C. H., Vaughan, E. M., Muir, J., Boumpas, D. T., Klippel, J. H., Balow, J. E., & Steinberg, A. D. (1996) · Annals of Internal Medicine · doi:10.7326/0003-4819-125-7-199610010-00003 · Cited by 607
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Metadata
- Authors
- Boumpas, D. T., Austin, H. A., Balow, J. E., Vaughan, E. M., Yarboro, C. H., Klippel, J. H., & Steinberg, A. D.
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1992-09
- Volume
- 340
- Issue
- 8822
- Pages
- 741-745
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1971058219
- Cited by
- 823
- References
- 0
- FWCI
- 15.48
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. https://app.cochat.ai/papers/10.1016/0140-6736(92)92292-n
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- Boumpas, D. T., Austin, H. A., Balow, J. E., Vaughan, E. M., Yarboro, C. H., Klippel, J. H., & Steinberg, A. D. (1992). Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. The Lancet. https://doi.org/10.1016/0140-6736(92)92292-n
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