Cyclophosphamide
Alkylating agent; potent immunosuppression, depletes B and T cells
- Response rate
- Effective for severe organ involvement
- Onset
- Weeks
- Route
- IV pulse or oral
- Line
- 3rd
- IgM effect
- Reduces anti-C1q antibody production
Evidence summary
Reserved for severe HUVS with major organ involvement (crescentic GN, severe vasculitis). Worm et al. demonstrated efficacy of cyclophosphamide-dexamethasone pulse therapy in 2 refractory patients. Often used as induction therapy before transitioning to mycophenolate or azathioprine for maintenance.