According to a study from Johns Hopkins University in Baltimore, short-term, high-dose cyclophosphamide (Cytoxan) appeared equivalent to the traditional lower dose monthly regimen for moderate-to-severe systemic lupus erythematosus (SLE).

The study randomized 51 patients with active disease to the traditional cyclophosphamide regimen or to 50 mg/kg daily for four days, stratifying them according to organ system involved (renal, neurologic, or other). Most patients were women and the majority were black. Half had renal disease, and smaller subsets had neurologic or other organ involvement.

The study found that not only were there no significant differences between the two main groups at six months, but there also were no differences in response rates to the two treatment regimens among the different organ subgroups. It also appears that in both groups, patients with neurologic disease had the best response rates, at 100% in the high-dose group and 71% in the traditional group.

Interesting, at 30 months, the neurologic subgroups fared best with both regimens and there was a suggestion that the monthly treatment resulted in better response in the renal subgroup leading investigators to recommend monthly cyclophosphamide remain as the preferred regimen for treating lupus nephritis.

On the down side, there were 29 hospitalizations in each group for complications including pneumonia, neutropenic fever, and meningococcemia. One patient in the high-dose group died of pneumonia and pulmonary fibrosis attributable to lupus, not to cyclophosphamide.

Cyclophosphamide is one of the most successful treatments for severe SLE. The drug is typically administered intravenously in monthly doses of 750 mg/m2 body mass index for six months, followed by maintenance quarterly infusions for two years. Long-term exposure to the drug can lead to numerous adverse events including infections, bone marrow destruction, and premature ovarian failure.

It was noted, however, that the low six-month responses for renal lupus with either cyclophosphamide regimen “makes it clear that other, more efficacious therapies need to be developed.”

You can read more details about this study at MedPageToday.com: High-Dose Lupus Treatment Works as Well as Low-Dose.