title: Stabilization of rapidly worsening multiple sclerosis for 36 months in patients treated with interferon beta plus cyclophosphamide followed by interferon beta.
abstract: Cyclophosphamide (CTX) is an alkylating agent related to nitrogen mustards whose anti-inflammatory and immunosuppressive effects have been utilised to treat selected cases of multiple sclerosis with a progressive and worsening course. To halt the progression of disease in patients refractory to disease modifying drugs CTX has been given, and several open-label studies have recently shown clinical benefits. In a previous study we demonstrated the effectiveness of a combination of IV monthly pulses of CTX and interferon beta (IFN-beta) in 10 patients with "rapidly transitional" form of multiple sclerosis characterised by severe and frequent attacks and rapid progression of disability. The present study reports the clinical and MRI follow-up 36 months after the discontinuation of CTX showing the maintenance of the results obtained in relapse rate (p<0.001), EDSS (p<0.001), T2 MRI total lesion load (p<0.001) and T2 lesions number (p<0.001) compared to the pre-treatment period. These encouraging findings and the absence of significant recorded side effects affirm that the association of CTX plus interferon-beta is amenable, safe and can be recommended in rapidly worsening MS patients.
authors.affiliation: Department of Neurological Sciences, Via Santa Sofia 78, 95123, Catania, Italy. patti@mbox.unict.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Patti
authors.forename: Ester
authors.initials: E
authors.lastname: Reggio
authors.forename: Filippo
authors.initials: F
authors.lastname: Palermo
authors.forename: Teresa
authors.initials: T
authors.lastname: Fiorilla
authors.forename: Guido
authors.initials: G
authors.lastname: Politi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nicoletti
authors.forename: Arturo
authors.initials: A
authors.lastname: Reggio
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D007166:Immunosuppressive Agents; D016899:Interferon-beta; D003520:Cyclophosphamide