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Cyclophosphamide treatment in active multiple sclerosis.

Enrique Gómez-Figueroa1,2, Efrain Gutierrez-Lanz3, Alonso Alvarado-Bolaños3

  • 1National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico. enrique.gomez@innn.edu.mx.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|January 16, 2021
PubMed
Summary

Cyclophosphamide (CYC) effectively stabilizes disability and reduces relapse rates in multiple sclerosis (MS) patients over 36 months. This immunosuppressive therapy shows particular benefit for those with active relapsing or malignant disease courses.

Keywords:
Active multiple sclerosisCyclophosphamideEfficacy

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Area of Science:

  • Immunology
  • Neurology
  • Pharmacology

Background:

  • Cyclophosphamide (CYC) is an immunosuppressive alkylating agent used for autoimmune diseases like multiple sclerosis (MS).
  • Its mechanism involves inhibiting DNA synthesis and inducing apoptosis.

Purpose of the Study:

  • To evaluate the efficacy of a monthly cyclophosphamide (CYC) treatment regimen.
  • To assess CYC's impact on relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS) patients.

Main Methods:

  • Retrospective analysis of 16 MS patients treated with CYC for at least 36 months.
  • Outcomes measured: Expanded Disability Status Scale (EDSS), annualized relapse rate (ARR), and progression index (PI) at 12, 24, and 36 months.
  • Comparison of disease course and activity impacts on treatment outcomes.

Main Results:

  • EDSS remained stable, with 62.5% of patients maintaining or improving their score at 12 months.
  • PI decreased by 14% at 12 months and 21% by 24-36 months.
  • ARR decreased significantly: 20% at 12 months, 19% at 24 months, and 30.23% at 36 months. Significant improvements in ARR and PI were observed in patients with high relapse activity and malignant disease courses.

Conclusions:

  • Cyclophosphamide (CYC) remains a viable therapeutic option for multiple sclerosis (MS).
  • It is particularly beneficial in resource-limited settings and for patients with high relapsing activity or malignant disease progression.