F A Houssiau, C Vasconcelos, D D’Cruz, G D Sebastiani, E de Ramon Garrido, M G Danieli, D Abramovicz, D Blockmans, A Cauli, H Direskeneli, M Galeazzi, A Gu¨l, Y Levy, P Petera, R Popovic, R Petrovic, R A Sinico, R Cattaneo, J Font, G Depresseux, J-P Cosyns, R Cervera
Objective: To update the follow-up of the Euro-Lupus Nephritis Trial (ELNT), a randomised prospective trial comparing low-dose (LD) and high-dose (HD) intravenous (IV) cyclophosphamide (CY) followed by azathioprine (AZA) as treatment for proliferative lupus nephritis.
Patients and methods: Data for survival and kidney function were prospectively collected during a 10-year period for the 90 patients randomised in the ELNT, except in 6 lost to follow-up.
Results: Death, sustained doubling of serum creatinine and end-stage renal disease rates did not differ between the LD and HD group (5/44 (11%) vs 2/46 (4%), 6/44 (14%) vs 5/46 (11%) and 2/44 (5%) vs 4/46 (9%), respectively) nor did mean serum creatinine, 24 h proteinuria and damage score at last follow-up. Most patients in both groups were still treated with glucocorticoids, other immunosuppressant agents and blood pressure lowering drugs. After 10 years of follow-up, the positive predictive value for a good outcome of an early drop in proteinuria in response to initial immunosuppressive therapy was confirmed.
Conclusion: The data confirm that a LD IVCY regimen followed by AZA—the ‘‘Euro-Lupus regimen’’—achieves good clinical results in the very long term.