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Evidence summaries

Cyclophosphamide Versus Methylprednisolone for Treating Neuropsychiatric Involvement in Sle

Cyclophosphamide might possibly be more effective in reducing symptoms of neuropsychiatric involvement in SLE compared with methylprednisolone but the evidence is insufficient. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding), and by imprecise results (few patients).

Summary

A Cochrane review [Abstract] 1 included 1 study with 32 subjects. Treatment response, defined as 20% improvement from basal conditions by clinical, serological and specific neurological measures, was found in more patients using cyclophosphamide compared with the methylprednisolone group at 24 months (table T1); the number needed to treat for an additional beneficial outcome (NNTB) of treatment response is 3. No statistically significant differences between the groups in damage index measurements (Systemic Lupus International Collaborating Clinics (SLICC)) were found. The median SLE Disease Activity Index (SLEDAI) rating favoured the cyclophosphamide group. Cyclophosphamide use was associated with a reduction in prednisone requirements. All the patients in the cyclophosphamide group had electroencephalographic improvement but there was no statistically significant difference in decrease between groups in the number of monthly seizures. No statistically significant differences in adverse effects, including mortality, were reported between the groups.

Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus

OutcomeFollow-up (mean)Relative effect (95% CI)MethylprednisoloneCyclophosphamide (95% CI)Participants (studies)
Response to treatment (20% improvement)*24 monthsRR 2.05 (1.13 to 3.73)462 per 1000947 per 1000 (522 to 1000)32 (1 study)
Seizures24 monthsRR 2.57 (0.92 to 7.14)333 per 1000856 per 1000(306 to 1000)11 (1 study)
Adverse events - Urinary tract infections24 monthsRR 0.86 (0.47 to 1.57)615 per 1000529 per 1000 (289 to 966)32 (1 study)
Adverse events - Death24 monthsRR 0.23 (0.03 to 1.96)231 per 1000531 per 1000 (7 to 453)32 (1 study)
*Response to treatment = 20% improvement from basal conditions on clinical, laboratory or specific neurological testing variables
Clinical comments

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