National Institute of Neurology and Neurosurgery, Manuel Velasco Suarez, Insurgentes Sur 3877, Tlalpan, 14269, Mexico City, Mexico.
The American British Cowdray Medical Center, Mexico City, Mexico.
Neurol Sci. 2021 Sep;42(9):3775-3780. doi: 10.1007/s10072-021-05052-1. Epub 2021 Jan 16.
Cyclophosphamide (CYC) is an alkylating agent with immunosuppressive effect by inhibiting DNA synthesis and producing apoptosis used in many autoimmune diseases, including multiple sclerosis (MS). Here, we analyze the efficacy of CYC treatment in relapsing-remitting (RRMS) and active secondary progressive MS (SPMS) in our center with a monthly scheme.
Patients with MS treated with CYC and a follow up of at least 36 months were eligible for inclusion. All participants had received a standard CYC regimen. The EDSS score mean annualized relapse rate (ARR) and progression index (PI) were measured as efficacy outcomes at 12, 24, and 36 months. Outcomes were also analyzed comparing disease course and activity.
A total of 16 patients were included (50% male, 18.75% RRMS and 81.25% SPMS). EDSS remained stable along the follow-up period, with 62.5% improving or maintaining the same EDSS score at 12 months. PI decreased 14% and 21% at 12 and 24-36 months of follow-up, respectively. ARR decreased 20% after 12 months, 19% after 24 months, and 30.23% after 36 months. Median differences in ARR were higher in patients with high relapse activity (0.60 vs 0.07, p = 0.001) and malignant course (0.60 vs 0.17, p = 0.027). PI also differed with higher mean differences in patients with high relapse activity (0.70 vs 0.03, p = 0.016) and malignant course (1.17 vs 0.03, p = 0.003).
CYC continues to be a valid therapeutic option, especially in regions with limited access to high-efficiency therapies particularly in patients with high relapsing activity and malignant course.
环磷酰胺（CYC）是一种烷化剂，具有免疫抑制作用，通过抑制 DNA 合成并产生细胞凋亡，用于多种自身免疫性疾病，包括多发性硬化症（MS）。在这里，我们分析了我们中心采用每月方案治疗复发缓解型（RRMS）和活跃的继发性进展型 MS（SPMS）的疗效。
符合纳入标准的患者为接受 CYC 治疗且随访时间至少 36 个月的 MS 患者。所有患者均接受了标准 CYC 方案治疗。在 12、24 和 36 个月时，EDSS 评分、平均年化复发率（ARR）和进展指数（PI）作为疗效指标进行测量。还比较了疾病病程和活动度来分析结果。
共纳入 16 名患者（50%为男性，18.75%为 RRMS，81.25%为 SPMS）。EDSS 在随访期间保持稳定，62.5%的患者在 12 个月时改善或保持相同的 EDSS 评分。PI 在 12-24 和 24-36 个月的随访中分别下降了 14%和 21%。ARR 在 12 个月时下降了 20%，在 24 个月时下降了 19%，在 36 个月时下降了 30.23%。在复发活动度高（0.60 与 0.07，p=0.001）和恶性病程（0.60 与 0.17，p=0.027）的患者中，ARR 的中位数差异更高。PI 也有所不同，在复发活动度高（0.70 与 0.03，p=0.016）和恶性病程（1.17 与 0.03，p=0.003）的患者中差异更大。
CYC 仍然是一种有效的治疗选择，特别是在难以获得高效治疗方法的地区，特别是在复发活动度高和恶性病程的患者中。
