Intensive Immunosuppression with Cyclophosphamide in Remittent Forms of Multiple Sclerosis. A Follow-Up of 134 Patients for 2–10 Years

Gonsette, R; Demonty, L.; Delmotte, P.

doi:10.1007/978-3-642-67554-6_74

Cited by 20 publications

(17 citation statements)

References 7 publications

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“…Cyclophosphamide has been shown to be effective in relapse rate reduction 1,2 and in control of MRI lesion accrual 1,3 ; however, effects in delaying disease progression have been variable. [4][5][6][7] Several studies have suggested that cyclophosphamide treatment may be most beneficial in younger adult patients, [7][8][9] and in patients with early secondary progressive MS. 6,7,10 MS onset before the age of 18 years is estimated at 2.7%-10.5% [11][12][13] of all patients. Children experience more frequent relapses than adults, suggesting a highly inflammatory disease.…”

mentioning

confidence: 99%

Cyclophosphamide therapy in pediatric multiple sclerosis

Makhani

Gorman²,

Branson³

et al. 2009

Neurology

120

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mentioning

confidence: 99%

Cyclophosphamide therapy in pediatric multiple sclerosis

Makhani

Gorman²,

Branson³

et al. 2009

Neurology

120

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“…Gonsette et al reported the clinical experience of 141 MS patients treated with intensive iv. CTX immunotherapy, concluding that intensive immunosuppression is able to stabilise the disease and interfere with the pathological process involved in the pathogenesis of MS [5]. Hommes et al treated 32 MS patients with CTX producing immunosuppression: benefits were shown especially in patients with shorter disease duration [9].…”

Section: Discussionmentioning

confidence: 98%

“…Cyclophosphamide (CTX) is an alkylating agent related to nitrogen mustards used in treatment of neoplastic and non-neoplastic immune-mediated inflammatory diseases [19,20]. Its anti-inflammatory and immunosuppressive effects have been utilized to treat selected cases of multiple sclerosis with progressive and worsening course without obtaining a general agreement on the efficacy of this drug in modifying the course of the disease [1,4,5,6,8,9,14]. However literature data suggest that CTX is efficacious in MS when inflammation predominates over the degenerative process in the CNS and JON 1857 ■ Abstract The aim of the present study was to evaluate the efficacy of the combination of cyclophosphamide (CTX) and interferon beta (IFN β) in a group of relapsing remitting (RR) multiple sclerosis (MS) patients who experienced treatment failure during IFN β therapy.…”

Section: Introductionmentioning

confidence: 99%

The combination of cyclophosphamide plus interferon beta as rescue therapy could be used to treat relapsing–remitting multiple sclerosis patients

et al. 2005

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The aim of the present study was to evaluate the efficacy of the combination of cyclophosphamide (CTX) and interferon beta (IFN beta) in a group of relapsing remitting (RR) multiple sclerosis (MS) patients who experienced treatment failure during IFN beta therapy. It is the general experience that immunomodulatory agents (IMA) are only partially effective in RR patients. Recent data on the efficacy of immunosuppressive therapies for these patients are encouraging. The anti-inflammatory and immunosuppressive effects of CTX have been utilized to treat selected cases of multiple sclerosis with a progressive and worsening course as rescue therapy. Thirty RR MS patients with clinically defined MS who experienced treatment failure during IFN beta therapy (2 or more relapses per year or 1.5 EDSS point worsening in one year) were enrolled in the study and treated with CTX iv pulse therapy added to IFN beta and followed up for 24 months. As primary endpoints we evaluated the yearly relapse rate. We also evaluated the percentage of patients free of relapses and of EDSS variations. We analysed the results at one year before entry (T0: IFN beta alone), 12 (T1) and 24 (T2) months after entry. Brain MRI was performed at T0, at T1 and T2. The 30 RR patients who had experienced a high number of relapses (rr =1.4) at T0 showed a significant improvement in yearly relapse rate (rr = 0.4) at T1 and a further improvement (rr = 0.17) at T2 (p < 0.001). The percentage of patients free of relapse was 70% at T2 (p < 0.0001). EDSS score changed from 2.6+/-1.23 at T0 to 2.2 +/- 1.5 at T2, showing only a trend of improvement. No significant variation of MRI lesion load and no severe adverse events were recorded during the study. These data showed that the combination of CTX plus IFN beta halted the progression of disease in active and deteriorating MS patients suggesting the necessity of RCTs to test the efficacy of this combination therapy in active RRMS patients or in patients who experienced treatment failure in response to disease modifying drugs (DMDs).

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“…It is used off-label for the treatment of many diseases, including lupus nephritis and MS. Initial open label trials demonstrated a beneficial effect in both relapsing and secondary progressive patients [11,12]. A randomized trial conducted by Hauser et al [13] found that progressive patients receiving cyclophosphamide in combination with adrenocorticotropic hormone (ACTH) did better than patients receiving plasmapheresis in combination with low-dose oral cyclophosphamide and ACTH or ACTH alone.…”

Section: Clinical Effects and Usementioning

confidence: 99%