Prospective study of low-dose cyclosporine A in patients with refractory lupus nephritis

Mod Rheumatol. 2007;17(2):92-7. doi: 10.1007/s10165-006-0545-8. Epub 2007 Apr 20.


We evaluated the efficacy and safety of low-dose cyclosporine A (CsA) in patients with refractory lupus nephritis. Nine patients with systemic lupus erythematosus who had lupus nephritis resistant to previous treatment with glucocorticoids and immunosuppressants other than CsA were enrolled in a prospective, open-label study. All patients initially received 2.5 mg/kg per day of CsA; the dosage was adjusted to reach a blood trough level of 80-150 ng/ml. The urinary protein concentration decreased significantly 2 weeks after the initiation of treatment. After 30 weeks of CsA treatment, the mean urinary protein concentration was more than 50% lower than the baseline value, and urinary casts had decreased significantly. There were no significant changes in the levels of serum creatinine, serum anti-double-stranded DNA antibodies, or CH50 during any part of the study. The dose of glucocorticoids was significantly tapered by approximately 50%, without any disease flare. Hypertension developed in one patient, but was controlled with antihypertensive agents. Our results suggest that low-dose CsA therapy is an effective and less toxic alternative to conventional cyclophosphamide therapy for the management of refractory lupus nephritis.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Antirheumatic Agents / therapeutic use
  • Cyclosporine / therapeutic use*
  • Dose-Response Relationship, Drug
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Lupus Erythematosus, Systemic / drug therapy*
  • Lupus Nephritis / drug therapy*
  • Male
  • Middle Aged
  • Prednisolone / therapeutic use
  • Prospective Studies
  • Treatment Outcome


  • Antirheumatic Agents
  • Glucocorticoids
  • Cyclosporine
  • Prednisolone