Continuous cyclophosphamide, prednisolone and azathioprine protocol
Induction phase 0–12 weeks
1) Cyclophosphamide 2 mg/kg/day
(Dosage reduction for renal failure – serum creatinine <250 mmol/1:2 mg/kg; 251–500: 1.75 mg/kg; >500: 1.5 mg/kg).
2) Prednisolone—maximum dose 60 mg/day.
| Time (weeks) | Dose (mg/kg) |
| 0–2 | 0.85 |
| 3–6 | 0.65 |
| 7–12 | 0.5 |
| 13–20 | 0.3 |
| 21–28 | 0.2 |
| 29–36 | 0.15 |
| 37–44 | 0.15/0.07 |
| 45–78 | 0.15/0 |
Remission phase 13–52 Weeks
1) Azathioprine 1.5 mg/kg/day.
2) Prednisolone reduce as per protocol above.
Maintenance phase
1) Prednisolone 0.15 mg/kg alternate days.
Protocol for the treatment of vasculitis with intermittent pulses of cyclophosphamide and prednisolone
| Phase | Time (week) | Pulse number | Route | Dose | Dose |
| | | | Cyclophosphamide | Prednisolone |
| Induction | 0,2,4 | 1–3 | iv | 15 mg/kg×1 | 10 mg/kg×1 |
| 7,10,13,17,21,25 | 4–9 | oral | 5 mg/kg×3 | 3.3mg/kg×3 |
| Remission | 30,35,40,46,52 | 10–14 | oral | 5 mg/kg×3 | 3.3 mg/kg×3 |
| Consolidation | 58,64,70,76 | 15–21 | oral | 5 mg/kg×3 | 3.3 mg/kg×3 |
Maintenance Oral prednisolone, 0.15 mg/kg alternate days.
MESNA is to be given in 3 oral doses totalling 75% of the dose of cyclophosphamide for every dose of
intravenous cyclophosphamide.
Dose adjustments are advised for the following reasons:
1) Maximum doses: The maximum bolus dose of cyclophosphamide, regardless of weight, will be 1000 mg.
The maximum bolus dose of prednisolone regardless of weight will be 1000 mg.
2) Cytopenia prior to bolus therapy: Delay bolus until count restored to above lower limit of normal
(WCC>3.5 or neutrophil count>2.0, platelets>140). If cytopaenia recurs, reduce cyclophosphamide
bolus by 25%.
3) Renal failure on bolus therapy: reduce as follows.
| Serum creatinine | Cyclo dose | Pred dose |
| <150 | 15 mg/kg | 10 mg/kg |
| 150–250 | 10 mg/kg | 10 mg/kg |
| 251–500 | 7.5 mg/kg | 10 mg/kg |
| >500 | 5 mg/kg | 7 mg/kg |
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