Is aggressive therapy effective for lupus?

Abstract

Intravenous cyclophosphamide is an effective form of aggressive therapy for the management of a wide range of serious manifestations of systemic lupus erythematosus. Although it has been best studied in patients with progressive lupus nephritis, recent evidence indicates an important role for this therapy for other clinical lupus indications, particularly acute neurologic diseases. The available comparative data suggest that intravenous cyclophosphamide is far more effective than intensive corticosteroid therapies, including conventional high-dose oral therapy as well as bolus intravenous therapy. Differences in efficacy compared with oral regimens of cyclophosphamide or azathioprine are less clear, although clinical experience would seem to suggest that intravenous cyclophosphamide has a more rapid onset of action clinically than low-dose oral therapies. Finally, the toxicity profile of intravenous cyclophosphamide compares favorably with other aggressive approaches to drug management and does not pose an unacceptable risk. The future impact of several current investigational therapies remains to be defined.