Cyclophosphamide: Time to Say Goodnight and Goodbye?

For over 20 years cyclophosphamide, either intravenous or oral, has been widely used in the treatment of patients with lupus nephritis, cerebritis and vasculitis. Although clearly beneficial for many patients, its propensity to cause haematological complications and reduced fertility has made it unpopular with both patients and physicians. The introduction of mycophenalate mofetil, and the exciting potential for other forms of therapy including B cell depletion, the B cell toleragen LJP394 and anti-BlyS antibodies, now makes it possible to consider the future of the treatment of patients with lupus without resorting to cyclophosphamide. This review considers how close we are to achieving this goal.