Treatment of systemic lupus erythematosus with cyclophosphamide

Cyclophosphamide is a potent immunosuppressive drug which is widely used to treat renal and central nervous system manifestation of Systemic Lupus Erythematosus (SLE). It is employed especially to prevent renal failure in lupus nephritis. Within the last decade intravenous cyclophosphamide bolus therapy has become the standard therapy in severe SLE due to its tendency towards a higher efficacy and fewer side effects as compared to oral application. Studies on the slightly more cost-effective oral cyclophosphamide bolus therapy have recently been published, however, there are no data on long-term results yet. Here, we review the effects and side effects of cyclophosphamide as well as recent clinical studies on cyclophosphamide bolus therapy in SLE. Because of the possible side effects, especially the high risk of malignancies, which sharply increases at a cumulative dose of approximately 60 g, cyclophosphamide should be used cautiously. Cyclophosphamide bolus therapy should only be performed in hospitals with special experience.