Low dose Cyclophosphamide

EUROLUPUS Nephritis Trial (ELNT)

Low dose Cyclophosphamide same efficacy as high dose with comparable efficacy

Cyclophosphamide 500mg 2 weekly for 6 doses=3g, vs NIH protocol 8.5g

MMF vs Cyclophosphamide

ALMS

Remission induction were similar

Responses were more common in black & latin

Ginzer et al,

MMF was superior than Cyclophosphamide

ACCESS

abatecept Vs Eurolupus showed abatecept is inferior

MMF vs Azathioprine

Cochrane review of 50 RCT

MMF was effective as Azathioprine as Induction

MMF was superior to Azathioprine as maintenance

Low risk of ovarian failure

Maintenance Rx with  MMF vs Azathioprine

MAINTAIN

Fewer renal flares in MMF. But not statistical significance