Cyclophosphamide

Although this drug is regarded as the gold standard for SLE, it is rarely needed for CLE (McCauliffe 2001, Wallace 2001). It may be applied at three dose levels (low, medium, and high, up to 50 mg/kg per day) and as pulse therapy. In a small study of low-dose cyclophosphamide (50-200 mg/d) comprising nine patients with DLE and SCLE, 50% showed an excellent response and another 30% a moderate response (Schulz and Menter 1971). Even with daily low doses of 100 mg, close monitoring of blood cell counts and liver enzymes has to be performed. Pulse therapy at 4-week intervals needs inward treatment and isolation to lower the risk of infection and is restricted to SLE manifestations. Apart from hematologic risks, both lung and urinary epithelia may be affected and may necessitate the prophylactic and timely application of mesna. Regarding the young age of most patients, the female preponderance, and the impact on reproduction, cyclophosphamide has to be critically evaluated, especially in the context of CLE.

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