J S CONWAY1, C WIJAYA1, S SEN1,2
1Department of Nephrology, Concord Repatriation General Hospital, Sydney, Australia, 2University of Sydney, Sydney, Australia
Aim: To evaluate the safety and efficacy of cyclophosphamide (CYC) prescribing within a tertiary renal unit.
Background: CYC is an alkylating agent with serious and toxic side effects, which aims to control rapidly progressive glomerulonephritides. Though recommendations exist, many units use trial based regimens on an ad-hoc basis.
Methods: All consecutive patients treated with CYC for a biopsy proven renal indication at Concord Repatriation General Hospital from January 2015 to July 2019 were identified through electronic pharmacy dispensary data and cross referenced with a list of all biopsies performed in the same period. Diagnosis, age, serum creatinine and urine protein excretion were recorded along with complications including infection, malignancy, adverse side effects, mortality and incident end stage renal disease (ESRD). Pre-treatment infectious disease screening and fertility counselling was also reviewed.
Results: 25 patients received intravenous (IV) CYC and one received oral therapy. 17 (65%) were treated for ANCA associated vasculitis; three (11%) for Class IV lupus nephritis; one (4%) for anti-glomerular basement membrane disease; two (8%) for IgA nephritis; two (8%) for membranous nephropathy and one for crescentic glomerulonephritis non-specified. Patients treated with IV CYC had similar disease response rates, rates of ESRD, and infectious complications compared with other published data. There was some variation in pre-treatment infectious disease screening, CYC dosing and regimens. One patient developed pneumocystis pneumonia as prophylaxis was discontinued.
Conclusion: Interventions to standardise care, such as multidisciplinary histopathology meetings and a prescribing tool allowing for structured follow-up and auditing of data may assist with long-term patient care. This would also allow for easier monitoring of patient and unit outcomes, especially as newer pharmacological agents are introduced to the market.
Dr Jessica Conway is a renal advanced trainee in her final year of training. She is currently working at Liverpool Hospital in NSW. Having completed a Masters of Public Health, she has a special interest in health services research and Indigenous health.