Revisited Cyclophosphamide in the Treatment of Lupus Nephritis

Table 2

Representative studies of cyclophosphamide treatment compared to MMF or calcineurin inhibitors.

	CY	MMF	Tacrolimus
Common mechanism	Inhibiting lymphocyte propagation (antiproliferation) [9]
Characteristics of respective mechanisms	Control vascular inflammatory lesions [57].	Inhibits T and B lymphocytes; Inhibits lesions of vascular endothelial cells [58].	Inhibits interleukin-10 and affects B lymphocyte function; Control the membranous lesions [59].
Efficacy comparison	Improves renal outcomes and have long been considered the gold standard for inducing renal remission and preventing renal flares [43].	The complete and total remission rates are comparable to CY [53].	Respond no inferior than CY and is more efficacious than MMF [56]; The effect of reducing urinary protein is stronger (stabilizing podocyte) [60].
Safety comparison	An increased risk of serious infections, myelosuppression, ovarian toxicity, and carcinogenic effect [46].	The risk of serious infections, leukopenia, gastrointestinal response, and ovarian toxicity was lower with MMF than with CY but easy to cause fetal malformation and abortion [53].	No reproductive inhibition and safe to use during pregnancy (better than MMF and CY) [61]; The risk of serious infections is lower with tacrolimus than with MMF and CY [61].