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Cyclophosphamide in chronic progressive multiple sclerosis: a comparative study

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Abstract

No effective treatment is presently available for progressive multiple sclerosis (MS). Cyclophosphamide (CFX), a cytotoxic immunosuppressive drug widely used in systemic dysimmune diseases, has been proposed for the treatment of multiple sclerosis with different schedules and controversial results. To evaluate the safety and clinical efficacy of CFX, we compared three different treatment schedules in patients with progressive MS: induction followed by bimonthly boosters for one year (17 patients); bimonthly boosters for one year without previous induction (15 patients); and monthly boosters for one year (21 patients). Survival analysis showed that the percentage of stable patients was significantly higher in the first and third treatment schedule groups. Myelotoxicity occurred in patients treated with induction and boosters (Group A). A high incidence of broncopneumonia was observed in patients undergoing the second treatment schedule (Group B). No major effects were observed in patients treated with monthly boosters (Group C). Response to treatment was limited to secondary progressive form. This study suggests that monthly treatment with CFX might be safely administered in progressive MS patients; its clinical efficacy must be confirmed by an appropriately designed clinical trial.

Sommario

A tutt’oggi non esiste un trattamento di prorata efficacia per la fase progressiva della sclerosi multipla (SM). La ciclofosfamide, un farmaco citotossico da anni utilizzato nel trattamento di patologie disimmuni sistemiche, è stato più volte adoperato impiegando diversi schemi di trattamento e ottenendo risultati differenti. Per valutare l’efficacia clinica e la tollerabilità di questo farmaco, abbiamo confrontato tre diversi schemi di trattamento: A) induzione seguita da boli bimensili per un anno (17 pazienti); B) boli bimensili per un anno non preceduti da induzione (15 pazienti); C) boli mensili per un anno (21 pazienti). La percentuale di malati stabili, analizzata mediante curva di sopravvivenza, è risultata significativamente più elevata nel primo e nel terzo gruppo. Nei pazienti trattati con lo schema A è stata perd osservata un’ alta incidenza di mielotossicità, tra i pazienti trattati secondo lo schema B vi sono stati diversi casi di broncopolmonite, mentre non sono stati rilevati effetti collaterali seri nel gruppo trattato con lo schema C. Il trattamento è risultato efficace solo nei malati con SM progressiva secondaria. Lo studio suggerisce che la ciclofosfamide può essere ben tollerata dai pazienti con SM: l’efficacia clinica del farmaco deve però essere confermata da uno studio disegnato per questo scopo.

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Authors and Affiliations

  1. Department of Neurology, National Neurological Institute “C. Besta”, Via Celoria 11, I-20133, Milan, Italy

    L. La Mantia, M. Eoli, A. Salmaggi & C. Milanese

  2. Institute of Pharmacological Research “Mario Negri”, Milano, Italy

    V. Torri

Authors
  1. L. La Mantia
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  2. M. Eoli
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  3. A. Salmaggi
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  4. V. Torri
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  5. C. Milanese
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La Mantia, L., Eoli, M., Salmaggi, A. et al. Cyclophosphamide in chronic progressive multiple sclerosis: a comparative study. Ital J Neuro Sci 19, 32–36 (1998). https://doi.org/10.1007/BF03028809

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  • DOI: https://doi.org/10.1007/BF03028809

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