环磷酰胺片剂的作用不应该被忽视

        环磷酰胺片剂治疗严重自身免疫性疾病(特别是红斑狼疮)的作用几乎被忽略到消失的边缘: 肾病医生是否应该引起重视?
        如果我们对自身免疫性疾病有了靶向治疗的方法，我们就能取得更确切的疗效，也能够把副作用降到最低程度。遗憾的是这一天的到来还离我们很远。现在的治疗方法虽然作用很强，但是没有特定的靶向，因而会产生同等程度的副作用，就像海浪一样。对于系统性红班狼疮，现在有二种药在竞争作为金标准的免疫抑制剂：静脉用环磷酰胺针剂(美国国立卫生研究所的标准方案及其改进方案)和口服霉酚酸酯片剂。至今，静脉用环磷酰胺被一些求新性的杂志冠以金标准的免疫抑制剂，但是并没有进行头对头的严格比较。环磷酰胺片剂并没有纳入到这种挑选金标准免疫抑制剂的比较研究之中，但是有证据表明环磷酰胺片剂的疗效相当于静脉用环磷酰胺和口服霉酚酸酯片剂，而和静脉用环磷酰胺相比费用更加经济、患者应用更加方便,并可能对非洲籍美国人更有效。在此，我们仅谈及环磷酰胺片剂治疗严重自身免疫性疾病的情况。我们猜测，如果环磷酰胺片剂能够纳入到这种对比性研究之中，它不会让人失望。

Hebert LA, Rovin BH.

Nephron Clin Pract. 2011;117(1):c8-c14. Epub 2010 Aug 3.

Oral cyclophosphamide is on the verge of extinction as therapy for severe autoimmune diseases (especially lupus): should nephrologists care?

Hebert LA, Rovin BH.

Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA.

Some day we will have powerful targeted therapies for autoimmune diseases. Remission will be induced efficiently. Side effects will be mere ripples. Unfortunately, that day is not imminent. Current  therapies are powerful but with unintended targets and side effects that can be equivalent to a sea change. For SLE, the current competition to select  the 'gold standard' immunosuppressant has come down to two regimens: intravenous cyclophosphamide (IVCY, standard NIH protocol or its variations) versus oral mycophenolate (MMF). Until recently, IVCY reigned as the gold standard, a title it achieved through a curious journey that did not involve rigorous head-to-head competition. Oral cyclophosphamide (POCY) has not been invited to the current competition to select the gold standard immunosuppressant despite the substantial evidence that POCY can perform. at least as well as IVCY or mycophenolate, and compared to IVCY, is far less expensive, easier for the patient, and maybe more effective in African-Americans. Here, we state the case for POCY as therapy for severe autoimmune diseases. We suggest that if POCY is allowed to compete, it will not disappoint.

(Nephron Clin Pract. 2011;117(1):c8-c14. Epub 2010 Aug 3.)