TREATMENT OF SEVERE SYSTEMIC LUPUS WITH MONTHLY INTRAVENOUS CYCLOPHOSPHAMIDE

患有严重系统性红斑狼疮的患者，主要是肾脏或神经系统疾病，将 每月接受环磷酰胺静脉滴注加治疗 每日口服强的松。在六个月结束时，将做出决定 关于令人满意地控制疾病活动的问题。患者 情况良好的患者将随机接受每日口服 硫唑嘌呤30个月或每3次静脉注射环磷酰胺 30个月。轻微照明弹的治疗效果将增加 强的松；主要照明弹将每月重新开始治疗 静脉注射环磷酰胺。服用硫唑嘌呤的病人 维持治疗将改为环磷酰胺维持治疗 心理治疗。该议定书的一个新特点将是使用 在所有合适的女性患者中植入孕激素(“Norpot”) 生育年龄。(在过去，我们通常使用诺普兰、 为此目的注射孕激素或口服避孕药)。

Patients with severe systemic lupus, primarily renal or neurologic, will be treated monthly with intravenous cyclophosphamide infusions plus daily oral prednisone. At the end of six months, a decision will be made regarding satisfactory control of disease activity. Patients who are doing well will be randomized to receive either daily oral azathioprine for 30 months or intravenous cyclophosphamide every 3 months for 30 months. Minor flares will be treated with increased prednisone; major flares will be treated by restarting monthly intravenous cyclophosphamide. Patients who flare on azathioprine maintenance therapy will be switched to cyclophosphamide maintenance therapy. A new feature of this protocol will be contraception using implanted progestins ("Norplant") in all suitable female patients of child-bearing age. (In the past we have generally used either Norplant, injectable progestins or oral contraceptives for this purpose).