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

Granulomatosis with polyangiitis in Northeastern Brazil: study of 25 cases and review of the literature

“…Improvement in kidney function after combination therapy with glucocorticoids and cyclophosphamide is well documented and is known to revert kidney damage in patients presenting with kidney failure [39]. In the present study, half the patients (4/8) treated endovenously with cyclophosphamide due to glomerulonephritis with creatinine clearance < 50 mL/min at the time of diagnosis recovered kidney function.…”

Granulomatosis with polyangiitis (Wegener's disease): An updated review of ocular disease manifestations

“…Once remission has been achieved, it is recommended that cyclophosphamide treatment to be continued for at least another year before tapering the medication. Both oral and intravenous cyclophosphamide, in combination with corticosteroids, have been used successfully with equal effectiveness (61,78,79). Because of the significant toxicity associated with cyclophosphamide therapy, alternative maintenance therapies have been used.…”

Clinical trial: cyclophosphamide pulse therapy – a promising therapeutic alternative in refractory Crohn’s disease

“…Consequently, the pulse regime is less toxic. 18,27,28 Common side effects are found to be infectious complications in 12.0% of patients. In all available studies, death occurred to a maximum of 4.2% of patients; however, these numbers are exclusively obtained from vasculitis patients and the observed fatalities have not been clearly correlated to either the underlying disease or cyclophosphamide treatment.…”