Immunosuppressive treatment in severe connective tissue diseases: effects of low dose intravenous cyclophosphamide

Martin-Suarez, Ignacio Javier; D’Cruz, David; Mansoor, M. A.; Fernandes, Ana Paula; Khamashta, Munther A.; Hughes, G. R. V.

doi:10.1136/ard.56.8.481

Cited by 113 publications

(49 citation statements)

References 25 publications

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“…Many studies have come to the conclusion that the effect of the low-dose therapy is comparable with the recommended high-dose regimen and with a considerably low incidence of infections [3,[11][12][13]. However, our results showed that the incidence of infections between the two groups had no notable differences.…”

Section: Discussioncontrasting

confidence: 58%

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Zhang

et al. 2014

Clin Rheumatol

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Cyclophosphamide (CYC) has long been considered a gold standard in inducing renal remission and preventing renal flares for patients with systemic lupus erythematosus (SLE). However, the rational use of CYC has not reached a consensus, such as the timing and length of treatment, the route of administration, and the ideal dosage. The objective of this study was to assess the efficacy and safety of short-interval lower-dose (SILD) intravenous (IV) CYC in the treatment of SLE. A total of 225 patients with lupus nephritis were randomly assigned to a 1-year trial, either the SILD group (12 fortnightly pulses at a fixed dose of 400 mg followed by 6 monthly pulses) or high-dose (HD) group (6 monthly pulses followed by two quarterly pulses at a dose of 0.5~1.0 g/m 2 ). At 6 months of treatment, 28 % (30/107) of patients in the SILD group reached a complete remission (CR), and 51.4 % (55/107) were in partial remission (PR), as compared with 32.7 % (35/107) and 45.8 % (49/107) in the HD group, respectively. Serum albumin, 24-h urinary protein, and the scores of disease activity were significantly improved in both groups at 6 months and maintained at the end of clinical trial. However, the SILD group showed much less menstrual disturbances (11.5 %), gastrointestinal adverse effects (5.3 %), and leukopenia (9.7 %) than the HD group (28.6, 26.8, and 19.8 %, respectively) at the end of clinical trial. The efficacy of the short-interval lower-dose (SILD) IV CYC regimen in the treatment of lupus nephritis is equivalent to that of the high-dose (HD) regimen, whereas the incidence of adverse events is much lower in the SILD group.

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Section: Discussioncontrasting

confidence: 58%

Short-interval lower-dose intravenous cyclophosphamide as induction and maintenance therapy for lupus nephritis: a prospective observational study

Zhang

et al. 2014

Clin Rheumatol

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“…Two open studies in Wegener's granulomatosis, 2 and in lupus nephritis showed encouraging results. 3 In particular, a markedly reduced incidence of ovarian failure was noted.…”

mentioning

confidence: 90%

The NIH pulse cyclophosphamide regime: the end of an era?

Karim

D’Cruz

2004

Lupus

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“…22 In our experience the use of lower doses of cyclophosphamide (500 mg per week or fortnightly for at least 3 pulses, followed when necessary by monthly 500 mg pulses) proved very effective in the treatment of NPSLE but with a lower incidence of side effects, especially herpes zoster and permanent ovarian failure, when compared with the NIH regimen. 19,23 In the present issue of Lupus, Stojanovich et al 24 report their experience in the treatment of NPSLE with low doses of intravenous cyclophoshamide (200 -400 mg per month), slightly lower than the St Thomas' Hospital regimen. In this pilot study, low doses cyclophosphamide treatment proved of bene t in most of the patients, especially in those who received treatment at the early signs of NPSLE.…”

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confidence: 99%