Safety and efficacy of intravenous pulse cyclophosphamide in acute steroid refractory inflammatory bowel disease

Stallmach, Andreas; Wittig, Burghardt; Moser, Cornelius; Fischinger, Johannes; Duchmann, Rainer; Zeitz, Martin

doi:10.1136/gut.52.3.377

Cited by 44 publications

(33 citation statements)

References 19 publications

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“…None of the 41 patients died under CPT, and only 3 patients had to terminate CPT due to side effects. This favorable safety profile was analogously observed in the previous studies analyzing CPT in CD [12,13,21]. In these studies, the mean cumulative dose of cyclophosphamide was around 3 g given as monthly pulses of 750 mg.…”

Section: Discussionsupporting

confidence: 64%

Cyclophosphamide Pulse Therapy in Severe Refractory Crohn's Disease: A Retrospective Multicenter Case Series

Bär

Krause²,

Stallmach

et al. 2017

Inflamm Intest Dis

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Background and Aims: In Crohn's disease (CD) patients still remain refractory to current regimens, including biologicals. Previous data from small single-center studies indicated cyclophosphamide pulse therapy (CPT) to be effective for induction of remission at least in steroid-refractory cases. The aim of the present study was to study the efficacy and safety of CPT in mainly tumor necrosis factor (TNF)-refractory complicated CD patients. Methods: Patients with refractory CD undergoing CPT were identified in 13 centers of the German IBD Study Group and retrospectively registered. In total, 41 patients (12 male, 29 female, median age 36 years, range 18-72 years) were included for analysis. Seventy-eight percent of these had previously been treated with thiopurines and 90% had previously received anti-TNF antibodies. Former steroid treatment was found throughout the cohort. Results: Patients received a median number of 5 (1-13) pulses every 28 (13-54) days in a period of 120 (12-411) days. A median dose of 766 (600-1,200) mg and a median cumulative dose of 4,500 (750-9,750) mg was given. A clinical response (reduction in the Harvey-Bradshaw Index [HBI] ≥2 points) was found in 68% of the patients and clinical remission (HBI <5 points) in 32%. Steroids could be reduced from 31 to 12 mg per day over all patients. Side effects were recorded in 71% (n = 29) of the patients. Three patients terminated CPT due to side effects. No patient died. Conclusion: Our data point to CPT as a therapeutic alternative for induction of remission in patients with severe refractory courses of CD including TNF antagonists. CPT might serve as bridging for maintenance treatment.

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Section: Discussionsupporting

confidence: 64%

Cyclophosphamide Pulse Therapy in Severe Refractory Crohn's Disease: A Retrospective Multicenter Case Series

Bär

Krause²,

Stallmach

et al. 2017

Inflamm Intest Dis

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“…Although our cohort of patients was rather small, our data substantially expand our knowledge about cyclophosphamide pulse therapy in severely active CD in addition to the 17 CD patients reported in the three recent studies. [19][20][21] Considering all documented CD cases (n = 32), cyclophosphamide pulse therapy rapidly achieved remission in 77%. Remission was sustained over 1 year in 54% of these severely affected and complicated group of CD patients.…”

Section: Discussionmentioning

confidence: 99%

“…18 Three recent uncontrolled studies addressed the efficacy and safety of pulsed cyclophosphamide in steroid refractory IBD. [19][20][21] An overall number of 22 patients were analysed (CD: n = 17; indeterminate colitis: n = 1; UC: n = 4). In these severely affected patients, cyclophosphamide pulse therapy showed an impressive efficacy.…”

Section: Introductionmentioning

confidence: 99%

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

Schmidt¹,

Fellermann²,

Wellhöner³

et al. 2009

Aliment Pharmacol Ther

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“…Cyclophosphamide has been recommended for the management of active vasculitis, and it was also reported that it could successfully induce remission in Crohn's disease and indeterminate colitis [12] . Cyclophosphamide had been given in our 3 steroid dependent patients; however it was ineffective.…”

Section: Discussionmentioning

confidence: 99%

A subset of ulcerative colitis with positive proteinase-3 antineutrophil cytoplasmic antibody

Xu¹,

Yang²,

Chen³

et al. 2008

WJG

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Safety and efficacy of intravenous pulse cyclophosphamide in acute steroid refractory inflammatory bowel disease

Cited by 44 publications

References 19 publications

Cyclophosphamide Pulse Therapy in Severe Refractory Crohn's Disease: A Retrospective Multicenter Case Series

Cyclophosphamide Pulse Therapy in Severe Refractory Crohn's Disease: A Retrospective Multicenter Case Series

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

A subset of ulcerative colitis with positive proteinase-3 antineutrophil cytoplasmic antibody

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