title: Role of oral cyclophosphamide in the treatment of giant cell arteritis.
abstract: OBJECTIVE
  Glucocorticoid (GC)-related adverse events greatly contribute to the outcome in giant cell arteritis (GCA). CYC was investigated as a steroid-sparing agent in GCA.
  
  
  METHODS
  Nineteen patients treated with CYC were retrospectively analysed. CYC was administered in 15 of the 19 patients after failure of high doses of GC or relapse during medium to high doses of GC, with or without MTX, while CYC was used ab initio in 4 of the 19 patients, all with type 2 diabetes. Follow-up ranged from 1 month to nearly 9 years after the end of CYC treatment.
  
  
  RESULTS
  The efficacy of CYC was observed in 15 of the 19 patients, and remission was still present 6-12 months after CYC suspension in 12 of the 13 patients. GCs were suspended in 6 of the 15 patients, and they were continued at a dose ≤5 mg/day of prednisone in all the remaining responders. Relapse occurred in 4 of the 15 patients, usually >12 months after CYC suspension. Suspension of GC daily dose or reduction to ≤5 mg/day of prednisone occurred within the first 6 months of follow-up after the beginning of CYC in 10 of the 15 patients. Ten adverse events were registered in nine patients, with recovery usually soon after the suspension of CYC or dose reduction. However, one death occurred due to acute hepatitis. Disappearance of the inflammatory infiltrate could be demonstrated when temporal artery biopsy was repeated 3 months after CYC in one patient.
  
  
  CONCLUSIONS
  CYC may represent a useful option for patients requiring prolonged medium- to high-dose GC therapy and at high risk of GC-related side effects.
authors.affiliation: Clinic of Rheumatology, AOU 'S. Maria della Misericordia' of Udine, Piazzale Santa Maria Misericordia 15, Udine, Italy. devita.salvatore@aoud.sanita.fvg.it
authors.forename: Luca
authors.initials: L
authors.lastname: Quartuccio
authors.forename: Marta
authors.initials: M
authors.lastname: Maset
authors.forename: Giovanna
authors.initials: G
authors.lastname: De Maglio
authors.forename: Elena
authors.initials: E
authors.lastname: Pontarini
authors.forename: Martina
authors.initials: M
authors.lastname: Fabris
authors.forename: Elisa
authors.initials: E
authors.lastname: Mansutti
authors.forename: Laura
authors.initials: L
authors.lastname: Mariuzzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Pizzolitto
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Beltrami
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone