Combination of cyclophosphamide and interferon-beta halts progression in patients with rapidly transitional multiple sclerosis

Patti, Francesco; Cataldi, Maria Lia; Nicoletti, Ferdinando; Reggio, Ester; Nicoletti, Alessandra; Reggio, A.

doi:10.1136/jnnp.71.3.404

Cited by 53 publications

(32 citation statements)

References 19 publications

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“…Immunosuppressor drugs (cyclophosphamide, and AZA) combined with plasma exchange failed in secondary progressive MS [7, 8]. Experimentation with the use of immunosuppressor drugs (cyclophosphamide [9], methotrexate [10], and AZA [11]) combined with IFN-β has also produced interesting findings; recently, Markovic–Plese et al [12]have reported an open-label study demonstrating a 69% reduction in the number of contrast-enhancing lesions during the combination therapy (AZA/IFN-β 1b ) in 6 patients. Controlled studies of combined AZA and IFN-β treatment are not yet available.…”

Section: Introductionmentioning

confidence: 99%

Azathioprine and Interferon β<sub>1a</sub> in Relapsing-Remitting Multiple Sclerosis Patients: Increasing Efficacy of Combined Treatment

Lus¹,

Romano²,

Scuotto³

et al. 2004

Eur Neurol

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Current treatments of relapsing-remitting multiple sclerosis (RRMS) with immunosuppressive or immunomodulatory drugs have been shown to modify the course of the disease in a significative number of patients. However, in many cases, the response to either interferon β (IFN-β) or azathioprine (AZA) treatments was not satisfactory and new therapeutic approaches are needed. We studied clinical and MRI efficacy, safety and tolerance of AZA and IFN-β_1a combined therapy in 23 patients with clinically definite RRMS, who had not previously been responsive to either monotherapies. Our cases were divided into three subgroups: 8 previously untreated patients (subgroup A) with at least 2 years of natural course of the disease, 8 patients (subgroup B) previously treated with AZA for 2 years and 7 patients (subgroup C) previously treated with IFN-β_1a for 2 years. The baseline Expanded Disability Status Scale (EDSS) ranged from 2 to 4 in all subgroups. All patients completed 2 years of combined treatment with a dose of AZA adjusted to reduce lymphocyte count down to 1,000 ± 100/µl in association with IFN-β_1a at a dose of 6 MIU every other day. The mean number of relapses during the combined treatment period was significantly lower than that observed before combined therapy in all the three subgroups. Also, the mean ΔEDSS score was significantly lower during combined treatment than in monotherapy in subgroups B and C. Moreover, after 2 years of combined treatment, the number of new T₁ hypointense lesions, the number and volume of proton density/T₂ hyperintense lesions and the gadolinium enhancement of T₁ hypointense lesions were significantly lower than before combined treatment. After 2 years of treatment, this combination therapy appears to be safe and well tolerated and no serious side effects were reported. Despite some limitations of our study design, the information regarding efficacy, safety and tolerance of the association of AZA and IFN-β is most encouraging.

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Section: Introductionmentioning

confidence: 99%

Azathioprine and Interferon β<sub>1a</sub> in Relapsing-Remitting Multiple Sclerosis Patients: Increasing Efficacy of Combined Treatment

Lus¹,

Romano²,

Scuotto³

et al. 2004

Eur Neurol

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“…After the second bolus of Cyc, he significantly improved; brain MR recorded a huge reduction of edema with partial remission of the dural contrast enhancement. The laboratoristic nadir, as suggested by Cyc use in aggressive forms of Multiple Sclerosis [1], was reached thirteen days after the first Cyc dose (WBC 2.43 × 10 3 /mmc, lymphocytes 0.39 × 10 3 /u). During the treatment, the patient had fever related to Staphylococcus epidermidis infection, which was promptly treated.…”

Section: Case Presentationmentioning

confidence: 99%

Wegener’s Granulomatosis Presenting as An Intracranial Hypertension Syndrome Treated with High Dose of Cyclophosphamide

Leone¹,

D’Amico²,

Platania³

et al. 2018

Med Case Rep

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Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare form of vasculitis. In this disorder, small-sized blood vessels in the nose, sinuses, ears, lungs and kidneys become inflamed and damaged. Other areas may also be affected in some cases. It can also produce a type of inflammatory tissue known as a granuloma that's found around the blood vessels. Granulomas can destroy normal tissue. It is the result of inflammation within the tissues called granulomatous inflammation and blood vessel inflammation ("vasculitis"), which can damage organ systems.

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“…Studies generally show that the onset of MRI effect is within 1-5 months [21]. Cyclophosphamide has also been used successfully in combination with IFN [22][23][24]. Despite different dosing schedules trials with cyclophosphamide have been consistent in showing that patients respond best if they are younger, have a shorter disease duration, and still have relapses or evidence of recent MRI activity [25,26].…”

Section: Clinical Effects and Usementioning

confidence: 99%

Role of Immunosuppressive Therapy for the Treatment of Multiple Sclerosis

et al. 2013

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Combination of cyclophosphamide and interferon-beta halts progression in patients with rapidly transitional multiple sclerosis

Cited by 53 publications

References 19 publications

Azathioprine and Interferon β<sub>1a</sub> in Relapsing-Remitting Multiple Sclerosis Patients: Increasing Efficacy of Combined Treatment

Azathioprine and Interferon β<sub>1a</sub> in Relapsing-Remitting Multiple Sclerosis Patients: Increasing Efficacy of Combined Treatment

Wegener’s Granulomatosis Presenting as An Intracranial Hypertension Syndrome Treated with High Dose of Cyclophosphamide

Role of Immunosuppressive Therapy for the Treatment of Multiple Sclerosis

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