Outcomes in patients with active lupus nephritis requiring immunosuppressives who never received cyclophosphamide

OBJECTIVE: To assess outcomes in patients with lupus nephritis treated with immunosuppressives compared to those treated with cyclophosphamide in a cohort study and in a matched cohort study. METHODS: Patients with active renal disease treated with immunosuppressive/cytotoxic medications were selected from the University of Toronto Lupus Clinic database. Five outcomes were evaluated: all-cause mortality, renal failure, reversal of active renal disease, relapse of active renal disease, and toxicity. RESULTS: There were no differences in the outcomes of death, renal failure, reversal or relapse of active renal disease, or toxicity in those using or not using cyclophosphamide. CONCLUSION: Antimetabolites should be considered standard of care for patients with lupus nephritis both for induction and for maintenance therapy.