Baca V et al. (2006) Effect of low-dose cyclosporine A in the treatment of refractory proteinuria in childhood-onset lupus nephritis. Lupus 15: 490–495

Lupus nephritis is a common cause of morbidity and mortality in children with systemic lupus erythematosus (SLE). Administration of intermittent intravenous cyclophosphamide improves the prognosis of severe lupus nephritis; however, as this treatment causes adverse effects and does not lead to remission in all patients, new therapies are needed. Baca et al. investigated the efficacy and safety of low-dose ciclosporin A in adolescents with lupus nephritis who were refractory to previous immunosuppressive therapy.

The study enrolled seven patients (aged 14–18 years) with biopsy-proven class III or IV lupus nephritis who had not achieved sustained remission of their disease with previous therapy involving corticosteroids and cytotoxic drugs. The patients received low-dose ciclosporin A (2.0–4.0 mg/kg/day) for 12 months; all patients also continued taking prednisone.

Before ciclosporin A treatment, all patients had proteinuria >1 g/24 h (median 2.5 g/24 h). Median 24 h urine protein levels decreased to 0.35 g/24 h after 6 months of treatment, and to 0.14 g/24 h after 12 months of treatment. Four of five patients followed up 3 months after cessation of ciclosporin A therapy, however, showed rapid increases in 24 h proteinuria, and 6 months after ciclosporin A discontinuation just one patient remained free of proteinuria and in SLE remission. Neither median creatinine clearance nor median serum creatinine level changed significantly following ciclosporin treatment. The median SLE disease activity index (SLEDAI) score decreased from 12 at baseline to 4 after 12 months of treatment (P = 0.027), and adverse effects related to ciclosporin A were mild.

Further studies are needed to determine whether long-term therapy or higher doses of ciclosporin A might confer sustained proteinuria remission after drug discontinuation.