Cytotoxic drug treatment of lupus nephritis.

Patients with lupus glomerulonephritis improved after various combinations of azathioprine or cyclophosphamide and prednisone treatment in uncontrolled studies reported in the early 1970s. Later prospective clinical trials tested the effectiveness of these cytotoxic immunosuppressants. No important differences were found in clinical effects, serologic tests of lupus activity, renal function, and proteinuria when groups of patients treated with prednisone were compared with those treated with combined azathioprine prednisone or cyclophosphamide prednisone. There has been a two-fold increase in the 5-yr cumulative survival of patients with diffuse proliferative lupus nephritis in studies appearing after 1970 versus those published before 1970. However, the improved survival cannot be attributed to azathioprine or cyclophosphamide treatment.