section name header

Evidence summaries

Cyclophosphamide for Multiple Sclerosis

Cyclophosphamide (CFX) may not prevent the risk of worsening in disabled patients with progressive multiple sclerosis (MS) in the long term, and major adverse effects are common. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 4 studies. Intensive immunosuppression with CFX (alone or associated with ACTH or prednisone) in patients with progressive MS compared to placebo or no treatment (152 participants) did not prevent the long-term (12, 18, 24 months) clinical disability progression as defined as evolution to a next step of Expanded Disability Status Scale (EDSS) score. However, the mean change in disability (final disability subtracted from the baseline) significantly favoured the treated group at 12 (effect size -0.21, 95% CI -0.25 to -0.17) and 18 months (-0.19, 95% CI -0.24 to -0.14) but favoured the control group at 24 months (0.14, 95% CI 0.07 to 0.21). The efficacy of other schedules could not be verified. Five patients died; sepsis and amenorrhea frequently occurred in treated patients (descriptive analysis).

    References

    • La Mantia L, Milanese C, Mascoli N, D'Amico R, Weinstock-Guttman B. Cyclophosphamide for multiple sclerosis. Cochrane Database Syst Rev 2007 Jan 24;(1):CD002819. [PubMed]

Primary/Secondary Keywords