Intensive immunosuppression with cyclophosphamide in multiple sclerosis

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

doi:10.1007/bf00316148

Cited by 99 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since at the end of the follow-up all the patients were stationary, our results agree with those of some previous studies, in which cyclophosphamide was used either in relapsing-remitting or in progressive MS [3,4,6]. These findings seem to demonstrate that an intensive short-term cyclophosphamide treatment can modify the clinical course of patients with severe chronic progressive MS. On the other hand, two studies that used historical controls did not show benefical effects of cyclophosphamide treatment [2,12].…”

Section: Discussionsupporting

confidence: 91%

“…In view of this, several regimes of treatment with a variety of immunosuppressive agents have been tried in MS, the ones that have been used most extensively being'azathioprine, plasmaexchange and cyclophosphamide [9,15]. In recent years cyclophosphamide has been used in two uncontrolled studies of patients with relapsing-remitting and chronic progressive MS [3,6] with a marked reduction of the annual relapse" rate or arrested progression in most of the patients treated. Hauser et al [4] used short-term high-dose cyclophosphamide in a controlled three-arm study, in which 80% of th.e patients with chronic progressive MS were neurologically stable at 1-year follow-up [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short-term intensive cyclophosphamide treatment in progressive multiple sclerosis

et al. 1987

View full text Add to dashboard Cite

14 patients with chronic progressive multiple sclerosis, selected in a preliminary uncontrolled trial, were given a short course of intensive cyclophosphamide therapy, which was discontinued when the leukocyte count fell to 3000 cu.mm. 5 patients dropped out because of severe side effects. At 1 year follow-up were neurologically unchanged since admission to the trial; 4 remained stable at 2 years. The lack of clinical improvement, the high frequency of side effects and the proven oncogenicity of cyclophosphamide led us to discontinue the trial.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Short-term intensive cyclophosphamide treatment in progressive multiple sclerosis

et al. 1987

View full text Add to dashboard Cite

show abstract

“…Cyclophosphamide has a long history in the treatment of MS, having been utilized in some of the first published treatment trials in this condition, 23,24 although at much lower doses than in this study. Cyclophosphamide effectively reduces the number of circulating T and B cells, 25,26 in addition to creating a more favorable cytokine balance, shifting away from autoimmune Th1 responses and reductions in interleukin 12 (IL-12) and interferon gamma (IFN-γ).…”

Section: Discussionmentioning

confidence: 93%

Treatment of relapsing–remitting multiple sclerosis with high-dose cyclophosphamide induction followed by glatiramer acetate maintenance

et al. 2011

View full text Add to dashboard Cite

Background Previous studies have described stabilization of aggressive multiple sclerosis (MS) with one-time induction therapy with high-dose cyclophosphamide (HiCy). The long-term benefit of this stabilization followed by conventional therapy has not been explored. Objective The objective of this study was to evaluate the safety and clinical outcomes following treatment of relapsing–remitting MS with HiCy induction therapy followed by glatiramer acetate maintenance. Methods A retrospective review of a closely followed population of thirty two MS patients treated with HiCy (200mg/kg intravenous infusion over 4 days) followed by maintenance with glatiramer acetate was performed. Results Annualized relapse rate was reduced from 1.37 in the 2 years prior to treatment to 0.27 over a mean post-treatment follow-up period of 14 months (range 0.5–33.8). The projected probability of relapse-free survival at 2 years was 0.64 (95% CI 0.37–0.82). The projected probability of Expanded Disability Status Scale (EDSS) progression-free survival at 2 years was 0.77 (95% CI 0.43–0.92). The mean number of gadolinium-enhanced lesions was reduced from 0.86 (SD 1.6) at baseline to 0 at 12 months and 0.08 (SD 0.28) at 15–24 months. A total of 55% of patients had no evidence of disease activity in follow-up. Infectious complications occurred in 47% with no long-term morbidity and no deaths. Conclusions Induction therapy with HiCy followed by long-term maintenance with glatiramer acetate is well tolerated in patients with MS, and appears to be efficacious in reducing the risk of relapse, disability progression, and new MRI lesions.

show abstract

“…In studies performed in the 1970s and 1980s intensive cyclophosphamide immunosuppression was reported as stabilizing the course of some patients with relapsing or progressive MS, although it should be noted that most of the subjects followed up for 10 years continued to have relapses [60][61][62][63][64]. Given the potential severity of cyclophosphamide early side effects (mainly alopecia, gastrointestinal intolerance and leukopenia with sepsis), and particularly of the long term risk of urinary bladder cancer [65], its use has been limited in recent years to aggressive or refractory MS forms, frequently in combination with other agents.…”

Section: Corticosteroidsmentioning

confidence: 94%

Current Status and Future Prospective of Immunointervention in Multiple Sclerosis

Cavaletti¹

2006

CMC

View full text Add to dashboard Cite

Multiple sclerosis (MS) is a complex neurological disorder characterized by inflammation and degeneration of the central nervous system, primarily involving the white matter. On the basis of a wide body of evidence in experimental models and in affected patients, several attempts to treat MS using drugs which modulate immune reactions have been performed or are currently ongoing. However, it should be stressed that inflammation does not have only a detrimental effect in MS. In fact, parts of the inflammatory events are crucial for the control and conclusion of the acute phase of damage and it is probable that they actually favor regeneration and recovery. Due to the above, several trials with immunosuppressant drugs failed or were suspended because of unexpected worsening of the course of MS. The knowledge of MS immunopathogenesis is so rapidly evolving that any attempt to review it is in some way frustrating. On the other hand, this evolution is at the basis of the several new treatment options which can be hypothesized for this disease. The current status of immunosuppression in MS and the possible future development of MS treatment will be reviewed, with particular reference to those treatments which have already been tested in clinical trials and which are based on sound evidence of a putative interference with specific events occurring in MS, with the sparing of general immunity.

show abstract

Intensive immunosuppression with cyclophosphamide in multiple sclerosis

Cited by 99 publications

References 17 publications

Short-term intensive cyclophosphamide treatment in progressive multiple sclerosis

Short-term intensive cyclophosphamide treatment in progressive multiple sclerosis

Treatment of relapsing–remitting multiple sclerosis with high-dose cyclophosphamide induction followed by glatiramer acetate maintenance

Current Status and Future Prospective of Immunointervention in Multiple Sclerosis

Contact Info

Product

Resources

About