Combination of Cyclophosphamide and Fludarabine for Lupus Nephritis: Tolerance, Toxicity, Efficacy and Effects on B and T Lymphocyte Regeneration
Studies at the NIH Clinical Center have shown that intermittent pulse cyclophosphamide
therapy is effective for treating patients with severe lupus nephritis, but may result in
substantial rates of sustained amenorrhea. Initial studies in patients with autoimmune
rheumatic diseases have also suggested a beneficial effect from the lymphocyte-specific
nucleoside analogs chlorodeoxyadenosine and fludarabine. Cyclophosphamide induces DNA
cross-links whereas, nucleoside analogs inhibits DNA repair indicating complementary and
partially synergistic modes of action. Whether combination of lower doses of
cyclophosphamide with nucleoside analogs will increase efficacy while at the same time
minimize toxicity from higher-cumulative doses of cyclophosphamide has not been determined.
In this phase I/II study, 15 patients with proliferative lupus nephritis will be treated as
outpatients with a combination of oral cyclophosphamide (500 mg/m(2)) on day 1 followed by
fludarabine (30 mg/m(2)) subcutaneously on days 1, 2 and 3 every month for 3 cycles. The
cumulative dose of cyclophosphamide in this regimen is approximately 2.5g as compared to
greater than or equal to 30g in the standard NIH cyclophosphamide regimen. In this study
the tolerance and toxicity of this combination will be studied. Regeneration of T and B
cells following depletion including analysis of antigen-repertoire and function will also be
examined. Preliminary efficacy information, including rates and time to renal remission and
rates of preservation of renal function, will be analyzed to be used for future controlled
studies. Pharmacokinetic analysis will be performed on a subset of patients to determine
the bioavailability and pharmacokinetic parameters of subcutaneous fludarabine.
Interventional
Endpoint Classification: Safety Study, Primary Purpose: Treatment
United States: Federal Government
980055
NCT00001676
January 1998
November 2002
Name | Location |
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) | Bethesda, Maryland 20892 |