Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Kidney Blood Press Res 2007;30:124–128 DOI: 10.1159/000101448 Treatment of Lupus Nephritis with Cyclosporine – An Outcome Analysis Zuzana Rihova a Zdenka Vankova a Dita Maixnerova a Ctibor Dostal b Eva Jancova a Eva Honsova c Miroslav Merta a Romana Rysava a Vladimir Tesar a a Nephrology Unit and b Institute for Rheumatology, 1st Medical Faculty, Charles University, and c Pathology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Introduction Renal involvement is common in systemic lupus ery- thematosus (SLE). An abnormal urinalysis with or with- out an elevated plasma creatinine concentration is pres- ent in approximately 50% of patients at the time of diag- nosis and eventually develops in more than 75% of cases [1]. Aggressive immunosuppressive therapy should be employed in patients with proliferative lupus nephritis (LN) as the risk of progression to end-stage renal disease is high. Combined treatment with cyclophosphamide (CYC) and corticosteroids (CS) is generally considered to be the induction treatment of choice for patients with WHO class III and IV LN as it improves renal survival. Prolonged administration of CYC and CS is also associ- ated with fewer relapses and a decreased risk of renal in- sufficiency [2] . However, its toxicity, especially in the light of the relapsing character of SLE with the potential need of repeated courses of immunosuppressive treat- ment and the need of non-gonadotoxic therapeutic op- tion for women in fertile age and in pregnancy, create the necessity of therapeutic alternatives. Cyclosporine (cy- closporine A, CsA) is a potent immunosuppressive agent with a powerful effect on helper T-clonal expansion and cytotoxic cell function through inhibition of IL-2, IL-3 and IFN-  synthesis. CsA had been shown to reduce pro- Key Words Cyclosporine  Lupus nephritis  Systemic Lupus Erythematosus Disease Activity Index – SLEDAI Abstract Background: The optimal therapy for lupus nephritis (LN), including the role of cyclosporine (CsA), still lacks scientifi- cally valid clinical experience. We evaluated the efficacy of CsA in the induction and maintenance treatment of patients with biopsy-proven LN. Patients and Methods: A total of 31 patients (25 women, 6 men, mean age 29.5 years) were en- rolled in the study. The majority had proliferative LN. The mean follow-up was 85.6 8 24.7 months. Results: CsA was used as first-line treatment in 38.7% of patients and as sec- ond-line treatment in 61.3% of patients. Complete remission was achieved in 93.5% of patients. The relapse rate was 45.2%. The mean disease-free interval was 33 months. At the end of follow-up, a total of 67.9% of the patients were in re- mission. The treatment led to significant improvement in proteinuria (p = 0.001) and stabilization of renal function. Conclusion: CsA might be an appropriate and a less toxic alternative drug for LN both as a first-choice and rescue therapy. Copyright © 2007 S. Karger AG, Basel Received: February 13, 2006 Accepted after revision: March 5, 2007 Published online: March 30, 2007 Zuzana Rihova, MD Nephrology Unit, 1st Medical Faculty, Charles University U Nemocnice 2 CZ–128 08 Prague 2 (Czech Republic) Tel. +420 224 962 663, Fax +420 224 962 696, E-Mail zrihova@centrum.cz © 2007 S. Karger AG, Basel 1420–4096/07/0302–0124$23.50/0 Accessible online at: www.karger.com/kbr Supported by the grant IGA MZ CR 8444-3.