title: Long-term follow-up of patients with scleroderma interstitial lung disease treated with intravenous cyclophosphamide pulse therapy: a single-center experience.
abstract: BACKGROUND
  Scleroderma lung disease (ILD-SSc) is treated mainly with cyclophosphamide (CYC). The effectiveness of CYC was judged after 12-24 months in most reports.
  
  
  OBJECTIVE
  To analyze the effect of monthly intravenous CYC on pulmonary function tests including forced vital capacity (FVC) and diffusing lung capacity (DLCO), as well as Rodnan skin score (mRSS), during long-term follow-up.
  
  
  METHODS
  We retrospectively collected the data on 26 ILD-SSc patients who began CYC treatments before 2007. Changes in FVC, DLCO and mRSS before treatment, and at 1,4 and 7 years after completion of at least six monthly intravenous CYC treatments for ILD-SSc were analyzed.
  
  
  RESULTS
  Mean cumulative CYC dose was 8.91 ± 3.25 G. More than 30% reduction in FVC (0%, 8%, and 31% of patients), DLCO (15%, 23%, 31%), and mRSS (31%, 54%, 62%) at years 1, 4 and 7 was registered. During the years 0-4 and 4-7, annual changes in FVC, DLCO and mRSS were 3.2 vs. 0.42% (P < 0.040), 4.6 vs. 0.89% (P < 0.001), and 1.8 vs. 0.2 (P = 0.002). The greatest annual FVC and DLCO reduction over the first 4 years correlated with mortality (P = 0.022). There were no differences in the main variables regarding doses of CYC (< 6 G and > 6 G).
  
  
  CONCLUSIONS
  In patients with ILD-SSc, CYC stabilized the reduction of FVC during treatment, but this effect was not persistent. The vascular characteristic of ILD-SSc (DLCO) was not affected by CYC treatment. CYC rapidly improved the mRSS. This effect could be achieved with at least 6 G of CYC. Higher rates of annual reduction in FVC and DLCO in the first 4 years indicate the narrow window of opportunity and raise the question regarding ongoing immunosuppression following CYC infusions.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir-Gurman
authors.forename: Mordechai
authors.initials: M
authors.lastname: Yigla
authors.forename: Ludmila
authors.initials: L
authors.lastname: Guralnik
authors.forename: Emilia
authors.initials: E
authors.lastname: Hardak
authors.forename: Anna
authors.initials: A
authors.lastname: Solomonov
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Rozin
authors.forename: Kohava
authors.initials: K
authors.lastname: Toledano
authors.forename: Amir
authors.initials: A
authors.lastname: Dagan
authors.forename: Rema
authors.initials: R
authors.lastname: Bishara
authors.forename: Doron
authors.initials: D
authors.lastname: Markovits
authors.forename: Menahem A
authors.initials: MA
authors.lastname: Nahir
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Braun-Moscovici
mesh_terms: D000328:Adult; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007557:Israel / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000150:complications*; D013995:Time; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide