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Pulse cyclophosphamide for severe neuropsychiatric lupus
D T Boumpas1, H Yamada, N J Patronas
1Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD.
The Quarterly Journal of Medicine
|December 1, 1991
Summary
Parenteral pulse cyclophosphamide effectively treats severe central nervous system (CNS) lupus erythematosus. This therapy led to significant recovery in most patients, even those unresponsive to corticosteroids, with minimal side effects.
Area of Science:
- Rheumatology
- Neurology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) can severely affect the central nervous system (CNS).
- CNS lupus often presents with neurological deficits or organic brain syndrome.
- High-dose corticosteroids are not always effective for severe CNS lupus.
Purpose of the Study:
- To evaluate the efficacy of parenteral pulse cyclophosphamide in patients with active SLE and severe CNS involvement.
- To assess the safety and tolerability of this therapeutic approach.
Main Methods:
- Nine patients with active SLE and CNS involvement received monthly intravenous cyclophosphamide (0.75-1.0 g/m2) for at least two months.
- Patients included those with focal neurological deficits, seizures, or organic brain syndrome.
- Treatment response and side effects were monitored.
Main Results:
- Eight out of nine patients achieved complete recovery or showed minor residual symptoms.
- Significant improvement was observed in patients with neurological deficits and organic brain syndrome.
- Cyclophosphamide therapy was generally well-tolerated with few adverse events.
Conclusions:
- Parenteral pulse cyclophosphamide is an effective adjunctive therapy for managing severe CNS manifestations of SLE.
- This treatment offers a viable option for patients refractory to corticosteroid therapy.
- The therapy demonstrates a favorable safety profile for CNS lupus management.