New approaches: A recent controlled study reported that mycophenolate mofetil is equally effective to a regimen of oral cyclophosphamide and azathioprine used sequentially in patients with proliferative lupus nephritis However, in this study follow up was short, patients had relatively mild disease and patients with high-risk factors were not included. A controlled study comparing mycophenolate mofetil to pulse cyclophosphamide is in progress. Other investigations explore the therapeutic

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... al of high-dose, immunoablative cyclophosphamide therapy alone or in combination with autologous stem cell transplantation, low-dose cyclophosphamide in combination with nucleoside analogues, or biologic response modifiers. High-dose cyclophosphamide or combinations of low-doses with fludarabine may result in profound bone marrow and immune suppression. Combinations of cyclophosphamide with biologic response modifiers have shown encouraging results in preclinical animal studies and may provide a major breakthrough in the treatment of severe lupus, similar to the introduction of cytotoxic agents a few decades ago.