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Clinical Pathway for Monthly Pulse Intravenous Cyclophosphamide Therapy for Lupus Nephritis
Author(s) -
Mirkov Sanja,
Thein Hla
Publication year - 2012
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2012.tb00188.x
Subject(s) - medicine , lupus nephritis , cyclophosphamide , adverse effect , creatinine , cumulative dose , systemic lupus erythematosus , gastroenterology , surgery , chemotherapy , disease
Aim To assess the outcomes of monthly pulse intravenous cyclophosphamide (IV CYC) therapy for lupus nephritis and to identify factors contributing to suboptimal outcomes. Method Historical study of clinical and laboratory data. Statistical analysis consisted of one sample paired 2‐tailed t ‐test and qualitative analysis of textual data. Results 16 patients received 17 courses of monthly pulse IV CYC from April 2004 to January 2008 (118 doses, median dose 1025 mg or 563 mg/m 2 , median cumulative dose 6960 mg or 3824 mg/m 2 ). Mean urinary protein decreased from 7.35 g/24 h pre therapy to 1.17 g/24 h (p = 0.01) after completion. Mean serum albumin increased from 25 to 35 g/L (p = 0.006). Mean serum creatinine was 105 μmol/L pre‐therapy and 122 μmol/L after treatment (p = 0.3). 9 patients achieved complete remission, 4 patients achieved partial remission, 2 patients progressed to end‐stage renal failure and 1 patient did not respond to treatment. 1 patient was lost to follow‐up. 9 out of 118 (8%) nadir white blood cell counts were below 3×10 9 /L and neutrophils were below 2×10 9 /L. 24 hospital admissions were due to the adverse effects of IV CYC. System deficiencies were identified relating to clinical documentation, monitoring laboratory data, patient support and coordinated care. Conclusion Although pulse IV CYC was effective, it was associated with serious adverse effects resulting in hospital admissions. The clinical pathway designed aims to improve efficiency and safety of pulse IV CYC for lupus nephritis.