Long-term clinical outcomes of synchronized therapy with plasmapheresis and intravenous cyclophosphamide pulse therapy in the treatment of steroid-resistant lupus nephritis

In recent years, the vital prognosis of the patients with lupus nephritis (LN) has improved dramatically as a result of steroid therapy and the administration of immunosuppressants including cyclophosphamide, but recurrent cases and complications associated with these therapies are a concern. In this study, a long-term retrospective evaluation was performed over a period of five years concerning the clinical characteristics, remission rate and relapse rate by dividing 38 patients with LN into three groups receiving either plasmapheresis (PP), intravenous cyclophosphamide pulse therapy (IVCY), or both PP and IVCY (synchronized PP-IVCY) as the treatments added to steroid therapy. The complete remission rates of PP, IVCY and PP-IVCY were 5/9 (55.6%), 8/16 (50.0%) and 9/13 (69.2%), respectively. The relapsing rates of PP, IVCY and PP-IVCY were 3/9 (33.3%), 3/16 (18.8%) and 1/13 (7.7%), respectively. Synchronized PP-IVCY therapy might be superior to PP or IVCY in achieving complete remission of LN, and in minimizing the risk of relapse of impaired renal function.