Cyclophosphamide and Fludarabine to Treat Lupus Nephritis

Launched by NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES (NIAMS) · Nov 3, 1999

Keywords

ClinConnect Summary

Studies at the NIH Clinical Center have shown that intermittent pulse cyclophosphamide therapy is effective for treating patients with severe lupus nephritis, but may result in substantial rates of sustained amenorrhea. Initial studies in patients with autoimmune rheumatic diseases have also suggested a beneficial effect from the lymphocyte-specific nucleoside analogs chlorodeoxyadenosine and fludarabine. Cyclophosphamide induces DNA cross-links whereas, nucleoside analogs inhibits DNA repair indicating complementary and partially synergistic modes of action. Whether combination of lower do...

Gender

ALL

Eligibility criteria

• • Patients must be 18 years of age or older and able to provide informed consent.
• • Patients must have at least 4 criteria for SLE as defined by the American Rheumatism Association (ARA).
• Active glomerulonephritis with:
• • Renal biopsy within 1 year with class III or class IV active lupus nephritis, AND;
• Abnormal urine analysis:
• • Greater than 10 RBC/hpf and cellular (RBC, WBC or mixed) casts, OR;
• • Greater than 10 RBC/hpf and proteinuria greater than 2 g/day, OR;
• • Proteinuria greater than 3.5 g/day.
• • No patients with severe proliferative lupus nephritis: a. very active renal histology with crescents or necrosis in more than 25% of glomeruli; or b. rapidly progressive glomerulonephritis (doubling of serum creatinine in less than or equal to 3 months); or c. severe impairment of renal function Cr greater than 2.5 mg/dL or GFR less than 50 mL/min measured by inulin clearance.
• Patient has not had previous immunosuppressive therapy:
• • Patients must not be receiving azathioprine, cyclosporine, methotrexate. Patients receiving these drugs will be eligible only if these drugs are discontinued and after a waiting period of greater than or equal to 4 weeks;
• Patients must not be receiving cyclophosphamide:
• • Greater than 3 pulses (maximum 1 g/m(2)/pulse) within the last 12 months or since last renal biopsy showing active disease; OR
• • greater than 6 pulses ever.
• • Patients must not have had pulse therapy with glucocorticoids or any experimental therapy during the 4 weeks before study entry.
• • Patients who need at study entry oral corticosteroids in dosages greater than 0.5 mg/kg/day of predisone to control extrarenal disease are not eligible.
• • Patients with active or chronic infection are not eligible.
• • Patients who are pregnant, breast-feeding or using inadequate birth control are not eligible.
• • Patients who have poorly controlled diabetes mellitus or with evidence of end-organ damage are not eligible.
• • No history of cerebrovascular accident, seizures within the last 5 years or chronic neurologic disease.
• • No history of malignancy other than squamous cell and/or basal carcinoma of the skin.
• No confounding medical illness that in the judgment of investigators would pose added risk for study participants such as:
• • Unstable coronary artery disease, cardiomyopathy or dysrhythmia requiring therapy;
• • Pulmonary disease (PFTs less 70% of predicted value or DLCO less than 60%), or;
• • Hematologic disease (Hb less than 8 mg/dL, platelets less than 100,000 micro liters or WBC less than 2,500/micro liters.