Treatment of Systemic Vasculitis With Cyclophosphamide and Steroids: Daily Oral Low-Dose Cyclophosphamide Administration After Failure of a Pulse Intravenous High-Dose Regimen in Four Patients

Généreau, T; Lortholary, Olivier; Leclerq, P; Grenet, D.; Tubery, M.; Sicard, Didier; Caubarrere, I.; Guillevin, Loı̈c

doi:10.1093/rheumatology/33.10.959

Cited by 44 publications

(21 citation statements)

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“…Some observers have suggested switching from pulse cyclophosphamide therapy to oral administration under such circumstances. However, this increases the drug toxicity [15,16].…”

Section: Discussionmentioning

confidence: 99%

Outcome of polyarteritis nodosa in northern India

Gupta

Kumar

Malaviya

1997

Rheumatology International

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Over the last 10 years, 17 patients (13 males and 4 females) diagnosed as having classical polyarteritis nodosa (PAN) were treated and followed up in the rheumatology clinic of our institute. The median age and duration of symptoms at presentation were 29 years (range 13-59) and 9.5 months, respectively. Patients presented with the typical clinical picture of classical PAN. The diagnosis was established with the help of an aortogram (7/10), sural nerve biopsy (7/8), muscle biopsy (5/7) and renal biopsy (3/4). For reasons not known, none of the 17 patients was HBsAg positive. Patients were treated with a combination of oral prednisolone (1 mg/kg per day) for 6 weeks, which was slowly tapered off over 6 months, and monthly intravenous cyclophosphamide pulses (15 mg/kg) for the first 6 months, followed by 3-monthly pulses for a total of 2 years. Remission was achieved in 14 patients after a median of 5 months of treatment. Remission was stable for a median of 5 years of follow-up. Three patients did not respond well and died within 6 months of diagnosis. The causes of death in these were intracerebral haemorrhage in one patient and gastrointestinal bleeding in two patients. This experience is in accord with the reported literature that classical PAN is mostly a monophasic disease with either an excellent response to the appropriate immunosuppressive therapy and a long remission or a downhill course culminating in death. A chronic course is rare.

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“…Some observers have suggested switching from pulse cyclophosphamide therapy to oral administration under such circumstances. However, this increases the drug toxicity [15,16].…”

Section: Discussionmentioning

confidence: 99%

Outcome of polyarteritis nodosa in northern India

Gupta

Kumar

Malaviya

1997

Rheumatology International

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“…When compared [36], the two CYC regimens were equally effective at controlling disease activity. Oral CYC has been successfully introduced when IV pulses failed to control disease activity or in the case of relapse within the first 6 months of treatment [37]. Treatment duration with CS and CYC should not exceed 1 year.…”

Section: Cyclophosphamidementioning

confidence: 99%

“…The dose is of 0.5 to 0.7 g/m 2 . Should pulses fail, oral CYC can be given successfully [44]. Conversely, pulse CYC is usually less or not effective when administered after failure of oral treatment [45].…”

Section: Treatment Of Wegener's Granulomatosismentioning

confidence: 99%

Advances in the Treatments of Systemic Vasculitides

Guillevin

2008

Clinic Rev Allerg Immunol

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Necrotizing systemic vasculitides are severe diseases in which prognosis improved since steroids and cytotoxic agents have been prescribed. The outcome is now better, and remission is obtained in more than 80% of patients. In this review paper, we will cover the indications of conventional treatments and new biotherapies and other therapies. The strategies that improve patient's outcome are discussed in the light of the prospective trials organized by international research groups.

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“…Much controversy exists over the use of intravenous cyclophosphamide [11][12][13][14][15][16]. Some investigators have advocated its use at the onset in a dose approximating 15 mg /kg at 3-4 -week intervals.…”

Section: Systemic Disease Ek Lk Elk With Acute or Subacute Clinicalmentioning

confidence: 99%

The treatment of Wegener's granulomatosis

DeRemee

1995

Clinical and Experimental Immunology

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Treatment of Systemic Vasculitis With Cyclophosphamide and Steroids: Daily Oral Low-Dose Cyclophosphamide Administration After Failure of a Pulse Intravenous High-Dose Regimen in Four Patients

Cited by 44 publications

References 0 publications

Outcome of polyarteritis nodosa in northern India

Outcome of polyarteritis nodosa in northern India

Advances in the Treatments of Systemic Vasculitides

The treatment of Wegener's granulomatosis

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