Intravenous pulse administration of cyclophosphamide versus daily oral treatment in patients with antineutrophil cytoplasmic antibody‐associated vasculitis and renal involvement: A prospective, randomized study

Abstract

Objective. There is growing concern about the toxic side effects of daily oral cyclophosphamide (CYC) treatment. Intravenous (IV) pulse administration of CYC has been shown to be effective in patients with systemic lupus erythematosus, but contradictory results have been reported in patients with antineutrophil and renal involvement. cytoplasmic antibody (ANCA)-associated vasculitis. significantly lower levels of follicle-stimulating hormone.Conclusion. This randomized study shows that lV CYC administration is an effective therapeutic tool with low toxicity in patients with ANCA-associated vasculitis Methods. The efficacy and toxicity of IV pulse administration of CYC (0.75 gm/m2) versus daily oral CYC treatment (2 mg/kg body weight) were investigated in a prospective, randomized, multicenter study in patients with ANCA-associated vasculitis and renal involvemen t.Results. The cumulative CYC dose was reduced by 57% in patients with IV pulse treatment (n = 22) compared with patients treated with daily oral therapy (n = 25). Patient survival, remission rate, time of remission, relapse rate, and outcome of renal function were not different between the 2 treatment groups.However, the rate of leukopenia (P < 0.01) and severe infections ( P < 0.05 by 1-tailed test) was significantly reduced in the IV pulse group compared with the group receiving daily oral treatment. Moreover, gonadal toxicity was reduced in the IV pulse group, as indicated by

Wegener granulomatosis in childhood and adolescence

“…They described a significant reduction of sideeffects in the intravenous pulse group compared with the patient group receiving daily oral treatment of cyclophosphamide. In particular, infections and gonadal toxicity were reduced in the intravenous pulse treatment group [28]. Most of these observations were confirmed by the study of Guillevin and coworkers [25], but in contrast they observed more relapses in the pulse cyclophosphamide treatment group.…”

“…To reduce treatment-related morbidity and mortality, intravenous pulse administration protocols of cyclophosphamide, which had been shown to be effective in patients with systemic lupus erythematousus, were compared with daily oral treatment of cyclophosphamide in WG [25,28]. In the study of Haubitz and coworkers [28], no differences were observed in survival and remission rate, time of remission, relapse rate and outcome.…”

“…In the study of Haubitz and coworkers [28], no differences were observed in survival and remission rate, time of remission, relapse rate and outcome. They described a significant reduction of sideeffects in the intravenous pulse group compared with the patient group receiving daily oral treatment of cyclophosphamide.…”

Diffuse recidivant alveolar hemorrhage in a patient with hepatitis C virus-related mixed cryoglobulinemia

“…This protocol was also applied in previous cases with alveolar hemorrhage and HCV-related mixed cryoglobulinemia [3,4]. Otherwise, in recent randomized trials, pulse regime is no more effective in improving mortality and important clinical outcomes than giving 2±5 mg/kg i. v. [16,17]. However its toxicity is clearly minor.…”

Rasch progrediente Glomerulonephritiden

“…Die i.v.-Bolusgabe von CYC, die von manchen Autoren propagiert wird, hat den Vorteil einer geringeren kumulativen CYC-Belastung und einer dadurch geringeren Nebenwirkungsrate [59]. Die Remissionsrate scheint mit der oralen CYC-Gabe vergleichbar,allerdings kommt es vermehrt zu Rezidiven [60].…”