Skip to main content
Top
Published in: Rheumatology International 4/2007

01-02-2007 | Original Article

Combination of intravenous pulses of cyclophosphamide and methylprednizolone in patients with systemic sclerosis and interstitial lung disease

Authors: George Yiannopoulos, Vassilios Pastromas, Ioannis Antonopoulos, George Katsiberis, George Kalliolias, Stamatis-Nick Liossis, Andrew P. Andonopoulos

Published in: Rheumatology International | Issue 4/2007

Login to get access

Abstract

The purpose of the study was to examine prospectively the efficacy and safety of the combination of intravenous pulses of cyclophosphamide and methylprednizolone, in the treatment of scleroderma lung disease. Thirteen patients were treated with the above combination for up to 24 months. Prior to this treatment, they underwent a pulmonary function evaluation and high resolution computed tomography (HRCT). Carbon monoxide diffusion lung capacity and forced vital capacity were repeated at 6, 12, 24 and 48 months. HRCT was repeated at the end of the treatment period, but in between and afterwards in some patients, as well. A significant percentage of patients (66.6%) showed stabilization or improvement of their pulmonary function. Patients with already seriously compromised function, before treatment, were the least likely to exhibit this evolution pattern. There was a tendency in some individuals to deteriorate on later evaluations, off treatment, although they had stabilized at the end of the treatment. There was rather a poor correlation between functional evolution and HRCT appearance. Finally, the regimen was well tolerated. Our results suggest that the employed combination is safe and effective, mainly in stabilizing the respiratory function of the patients. This goal is more realistic when treatment is given before significant functional compromise has ensued. The need for long-term immunosuppression to maintain the initial favorable response is suggested.
Literature
1.
go back to reference Silver RM, Warrick JH, Kinsella MB, Staudt LS, Baumann MH, Strange C (1993) Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis (scleroderma) with interstitial lung disease. J Rheumatol 20:838–844PubMed Silver RM, Warrick JH, Kinsella MB, Staudt LS, Baumann MH, Strange C (1993) Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis (scleroderma) with interstitial lung disease. J Rheumatol 20:838–844PubMed
2.
go back to reference Steen VD, Lanz JK, Conte C, Owens GR, Medsger TA (1994) Therapy for severe interstitial lung disease in systemic sclerosis: a retrospective study. Arthritis Rheum 37:1290–1296PubMedCrossRef Steen VD, Lanz JK, Conte C, Owens GR, Medsger TA (1994) Therapy for severe interstitial lung disease in systemic sclerosis: a retrospective study. Arthritis Rheum 37:1290–1296PubMedCrossRef
3.
go back to reference Akesson A., Scheja A, Lundin A, Wollheim F (1994) Improved pulmonary function in systemic sclerosis after treatment with cyclophosphamide. Arthritis Rheum 37:729–735 PubMedCrossRef Akesson A., Scheja A, Lundin A, Wollheim F (1994) Improved pulmonary function in systemic sclerosis after treatment with cyclophosphamide. Arthritis Rheum 37:729–735 PubMedCrossRef
4.
go back to reference Clements P, Furst DE, Silver RM, Tashkin DP, Roth MD, Goldin J, Elashoff RM,Sterz MG, for the SLS Investigators (2005) The Scleroderma Lung Study (SLS) shows the beneficial effects of cyclophosphamide over placebo in systemic sclerosis patients with active alveolitis. Arthritis Rheum 52(Suppl:s257) Clements P, Furst DE, Silver RM, Tashkin DP, Roth MD, Goldin J, Elashoff RM,Sterz MG, for the SLS Investigators (2005) The Scleroderma Lung Study (SLS) shows the beneficial effects of cyclophosphamide over placebo in systemic sclerosis patients with active alveolitis. Arthritis Rheum 52(Suppl:s257)
5.
go back to reference Schnabel A, Reuter M, Gross WL (1998) Ιntravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular disease. Arthritis Rheum 41:1215–1220PubMedCrossRef Schnabel A, Reuter M, Gross WL (1998) Ιntravenous pulse cyclophosphamide in the treatment of interstitial lung disease due to collagen vascular disease. Arthritis Rheum 41:1215–1220PubMedCrossRef
6.
go back to reference Davas EM, Peppas C, Maragou M, Alvanou E, Hondros D, Dantis PC (1999) Intravenous cyclophosphamide pulse therapy for the treatment of lung disease associated with scleroderma. Clin Rheumatol 18:455–461PubMedCrossRef Davas EM, Peppas C, Maragou M, Alvanou E, Hondros D, Dantis PC (1999) Intravenous cyclophosphamide pulse therapy for the treatment of lung disease associated with scleroderma. Clin Rheumatol 18:455–461PubMedCrossRef
7.
go back to reference Varai G, Earle L, Jimenez SA, Steiner RM, Varga J (1998) A pilot study of intermittent intravenous cyclophosphamide for the treatment of systemic sclerosis associated lung disease. J Rheumatol 25:1325–1329PubMed Varai G, Earle L, Jimenez SA, Steiner RM, Varga J (1998) A pilot study of intermittent intravenous cyclophosphamide for the treatment of systemic sclerosis associated lung disease. J Rheumatol 25:1325–1329PubMed
8.
go back to reference Pakas I, Ioannidis JP, Malagari K, Skopouli FN, Moutsopoulos HM, Vlachoyiannopoulos PG (2002) Cyclophosphamide with low or high dose prednisolone for systemic sclerosis lung disease. J Rheumatol 29:298–304PubMed Pakas I, Ioannidis JP, Malagari K, Skopouli FN, Moutsopoulos HM, Vlachoyiannopoulos PG (2002) Cyclophosphamide with low or high dose prednisolone for systemic sclerosis lung disease. J Rheumatol 29:298–304PubMed
9.
go back to reference Giacomelli R, Valentini G, Salsano F, Cipriani P, Sambo P, Conforti ML, Fulminis A, De Luca A, Farina G, Candela M, Generini S, De Francisci A, Tirri E, Proietti M,Bombardieri S, Gabrielli A, Tonietti G, Gerinic MM (2002) Cyclophosphamide pulse regimen in the treatment of alveolitis in systemic sclerosis. J Rheumatol 29:721–736 Giacomelli R, Valentini G, Salsano F, Cipriani P, Sambo P, Conforti ML, Fulminis A, De Luca A, Farina G, Candela M, Generini S, De Francisci A, Tirri E, Proietti M,Bombardieri S, Gabrielli A, Tonietti G, Gerinic MM (2002) Cyclophosphamide pulse regimen in the treatment of alveolitis in systemic sclerosis. J Rheumatol 29:721–736
10.
go back to reference Griffiths B, Miles S, Moss H, Robertson R, Veale D, Emery P (2002) Systemic sclerosis and interstitial lung disease: a pilot study using pulse intravenous methylprednisolone and cyclophosphamide to assess the effect on high resolution computed tomography scan and lung function. J Rheumatol 29:2371–2378PubMed Griffiths B, Miles S, Moss H, Robertson R, Veale D, Emery P (2002) Systemic sclerosis and interstitial lung disease: a pilot study using pulse intravenous methylprednisolone and cyclophosphamide to assess the effect on high resolution computed tomography scan and lung function. J Rheumatol 29:2371–2378PubMed
11.
go back to reference Airò P, Danieli E, Parrinello G, Antonioli CM, Cavazzana I, Toniati P, Franceschini F, Cattaneo R (2004) Intravenous cyclophosphamide therapy for systemic sclerosis. A single-center experience and review of the literature with pooled analysis of lung function test results. Clin Exp Rheumatol 22:573–578PubMed Airò P, Danieli E, Parrinello G, Antonioli CM, Cavazzana I, Toniati P, Franceschini F, Cattaneo R (2004) Intravenous cyclophosphamide therapy for systemic sclerosis. A single-center experience and review of the literature with pooled analysis of lung function test results. Clin Exp Rheumatol 22:573–578PubMed
12.
go back to reference Kowal-Bielecka O, Kowal K, Rojewska J, Bodzenta-Lukaszyk A, Siergiejko M, Sierakowska M, Sierakowski S (2005) Cyclophosphamide reduces neutrophilic alveolitis in patients with scleroderma lung disease: a retrospective analysis of serial bronchoalveolar lavage investigations. Ann Rheum Dis 64:1343–1346PubMedCrossRef Kowal-Bielecka O, Kowal K, Rojewska J, Bodzenta-Lukaszyk A, Siergiejko M, Sierakowska M, Sierakowski S (2005) Cyclophosphamide reduces neutrophilic alveolitis in patients with scleroderma lung disease: a retrospective analysis of serial bronchoalveolar lavage investigations. Ann Rheum Dis 64:1343–1346PubMedCrossRef
13.
go back to reference Warrick JH, Bhalla M, Schabel SI, Silver RM (1991) High resolution computed tomography in early scleroderma lung disease. J Rheumatol 18:1520–1528PubMed Warrick JH, Bhalla M, Schabel SI, Silver RM (1991) High resolution computed tomography in early scleroderma lung disease. J Rheumatol 18:1520–1528PubMed
Metadata
Title
Combination of intravenous pulses of cyclophosphamide and methylprednizolone in patients with systemic sclerosis and interstitial lung disease
Authors
George Yiannopoulos
Vassilios Pastromas
Ioannis Antonopoulos
George Katsiberis
George Kalliolias
Stamatis-Nick Liossis
Andrew P. Andonopoulos
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 4/2007
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-006-0217-1

Other articles of this Issue 4/2007

Rheumatology International 4/2007 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.