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IV Cyclophosphamide Protocols for Systemic Lupus Erythematosus

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Disease Complication	Regimen[a]
Lupus nephritis[b]	Induction therapy for lupus nephritis: 500 mg on weeks 0, 2, 4, 6, 8, and 10[c]
Organ- or life-threatening disease	0.75 to 1 g/m² BSA/month for 6 months[d,e]
Mesna is given in a dose equal to cyclophosphamide. Mesna binds acrolein, which is a metabolite of cyclophosphamide that irritates the bladder.
[b] See also table Classification of Lupus Nephritis.
[c] Euro-Lupus regimen.
[d] Cyclophosphamide should not be used after this period.
[e] National Institutes of Health regimen.
BSA = body surface area.
Adapted from Fanouriakis A, Kostopoulou M, Alunno A, et al: 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 78(6):736–745, 2019. doi: 10.1136/annrheumdis-2019-215089