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Rescue cyclophosphamide for severe multiple sclerosis relapses.

Vlad C Bibic, Robert Carruthers, Daniel Hong

  • 1Division of Neurology, Department of Medicine, University of British Columbia MS Clinic, Vancouver, BC, Canada.

Multiple Sclerosis Journal - Experimental, Translational and Clinical
|March 26, 2026
PubMed
Summary
This summary is machine-generated.

Cyclophosphamide may improve disability scores in aggressive multiple sclerosis (MS) patients who do not respond to initial relapse treatments. This study reviewed its use as rescue therapy, showing potential benefits for severe MS relapses.

Keywords:
Multiple sclerosiscyclophosphamidedemyelinationdisease-modifying therapiessafetytreatment response

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Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Aggressive multiple sclerosis (MS) is characterized by rapid disability accumulation and severe relapses.
  • Standard initial treatments include high-dose IV corticosteroids and plasmapheresis.
  • Limited options exist for patients unresponsive to initial therapies, with cyclophosphamide used off-label.

Purpose of the Study:

  • To evaluate the effectiveness of cyclophosphamide as a rescue therapy in multiple sclerosis (MS) patients at the UBC MS Clinic.
  • To assess the role of cyclophosphamide in managing severe MS relapses when standard treatments fail.

Main Methods:

  • Retrospective chart review of MS patients treated with cyclophosphamide between June 2009 and June 2024.
  • Screening of the UBC MS Clinic pharmacy database to identify eligible patients.
  • Analysis of Expanded Disability Status Scale (EDSS) scores before and after cyclophosphamide treatment.

Main Results:

  • The median pre-treatment EDSS score was 6 (range 2.5-9).
  • Thirteen out of 23 patients (56.5%) experienced an improvement in their EDSS score.
  • Six out of 23 patients (26.1%) showed a significant improvement of ≥3 points in EDSS.

Conclusions:

  • Cyclophosphamide treatment demonstrated an association with improved EDSS scores in relapsing MS patients.
  • This study suggests a potential role for cyclophosphamide as a rescue therapy for severe MS relapses, even with available high-efficacy disease-modifying therapies (DMTs).