Cyclophosphamide-induced lupus flare in diffuse proliferative lupus nephropathy
Brote lúpico durante la inducción con ciclofosfamida en la nefropatía lúpica proliferativa difusa
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Although they question whether cyclophosphamide really induces the flare or whether other mechanisms are involved, we would like to clarify that the title of the English version “Cyclophosphamide-induced lupus flare” could lead readers to believe that we consider that treatment with cyclophosphamide induced the flare, however, we wanted to communicate exactly the opposite. Indeed, as was reflected in the “Discussion” section, cyclophosphamide treatment is the best immunosuppressive agent, with the best results in inducing remission in severe forms of lupus nephropathy (LN).<span class="elsevierStyleSup">2</span> As Park at al have pointed out in their letter, the lupus flare may or may not occur after cyclophosphamide treatment. In our case, it was during the cyclophosphamide induction period (less than 15 days). The flare was confirmed following the first phosphamide dose. Therefore, after having dismissed several causes (renal vein thrombosis, infection, etc.), we brought another cyclophosphamide dose forward (the second dose was 1.5g), which caused clinical and biochemical improvements, and the patient went into remission. To date, the patient has not had any further flares. We would like to emphasise the importance of the cyclophosphamide administered: we used the Euro-Lupus Nephritis Trial regime, 500mg every 15 days.<span class="elsevierStyleSup">3</span> In this patient the flare would have been earlier, since the relapse occurred less than 15 days with 1g of the first dose of cyclophosphamide. For that reason, before considering cyclophosphamide treatment to be ineffective, it is important to bear in mind the dose that has been administered. Finally, we must highlight that we did not consider for one moment that cyclophosphamide induced the lupus flare.</p>" "pdfFichero" => "P1-E524-S3360-A11029-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Heras M, Saiz A, Fernández-Reyes MJ, Sánchez R, Zurita P, Urrego C. Brote lípico durante la inducción con ciclofosfamida en la nefropatía lúpica proliferativa difusa. Nefrologia 2011;31(2):231-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21461001" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Burchadi C, Schlöndorff D. Induction theraphy for active lupus nephritis: mycophenolate mofetil versus cyclophosphamide. Nat Clin Pract Nephrol 2006;2:314-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16932452" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Houssiau FA.Cyclophosphamide in lupus nephritis. Lupus 2005;14:53-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15732289" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052447/v0_201502091634/en/main.assets" "Apartado" => array:4 [ "identificador" => "35439" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Comments on published articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000005/v0_201502091634/X2013251411052447/v0_201502091634/en/P1-E524-S3360-A11029-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052447?idApp=UINPBA000064" ]
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