Retrospective analysis of infections prevalence in patients with progressive systemic sclerosis treated with cyclophosphamide
AbstractAim. Assessment of infections prevalence rate, type and severity in patients diagnosed with progressive systemic sclerosis (PSS), treated with cyclophosphamide (CTX), during 12 months of observations. Material and methods. A retrospective analysis of mild, moderate and severe infections in 17 women with a mean age of 58.8 ± 10.0, based on an interview, physical examination, additional tests, and available medical records. Results. 46 various infections were diagnosed in the analysed group of patients. 32 (69.6%) infections involved the respiratory system, and 14 (30.4%) infections concerned the urinary tract. The average frequency per one patient was 2.7 ± 3.5 (median: 2) events during 12 months of observations. The majority of infections, 60.9 % (n = 28), were mild ones of slight intensity, and 37.0% (n = 17) were moderate ones. Only one person (2.2% of all infections) had a severe infection requiring hospitalisation.Conclusions. In the studied group the infection prevalence rate was comparable to that in a healthy population. The majority of infections were mild and involved the respiratory system. Basis of conducted analysis 12 months intravenous administration of CTX is not a factor significantly increasing a risk of severe infections in the studied group of patients. In PSS patients CTX pulse therapy is relatively safe, as it does not cause severe infections requiring hospitalisation
Manno R, Boin F. Immunotherapy of systemic sclerosis. Immunotherapy. 2010 Nov;2(6):863–878.
DeZern AE, Petri M, Drahman DB et al. High dose cyclophosphamide without stem cell rescue in 207 patients with aplastic anemia and other autoimmune diseases.
Tashkin DP, Elashoff R, Clements PJ et al. Scleroderma Lung Study Research Group. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med. 2006 Jun 22;354(25):2655–66.
Akesson A, Scheja A, Lundin A et al. Improved pulmonary function in systemic sclerosis after treatment with cyclophosphamide. Arthritis Rheum. 1994 May;37(5): 729–35.
Hoyles RK, Ellis RW, Wellsbury J et al. A multicenter, prospective, randomized, double-blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma. Arthritis Rheum. 2006;54:3962–70.
Silver RM, Warrick JH, Kinsella MB et al. Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis (scleroderma) with interstitial lung disease. J Rheumatol. 1993 May;20(5):838–44.
Davas EM, Peppas C, Maragou M et al. Intravenous cyclophosphamide pulse therapy for the treatment of lung disease associated with scleroderma. Clin Rheumatol. 1999;18(6):455–61.
White B, Moore WC, Wigley FM et al. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis. Ann Intern Med. 2000 Jun 20;132(12):947–54.
Dezern AE, Styler MJ, Drachman DB et al. Repeated treatment with high dose cyclophosphamide for severe autoimmune diseases. Am J. Blood Res. 2013;3(1):84–90.
Kowal-Bielecka O, Landewé R, Avouac J et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis. 2009 May;68(5):620–8.
Haga HJ, D'Cruz D, Asherson R et al. Short term effects of intravenouspulses of cyclophosphamide in the treatment of connective tissue disease crisis. Ann Rheum Dis. 1992 Jul;51(7):885–8.
Tehlirian CV, Hummers LK, White B et al. High-dose cyclophosphamide without stem cell rescue in scleroderma. Ann Rheum Dis. 2008 Jun;67(6):775–81.
D'Angelo S, Cuomo G, Paone C et al. Low-dose intravenous cyclophosphamide in systemic sclerosis: a preliminary safety study. Clin Rheumatol. 2003 Dec;22(6):393–6.
Tochimoto A, Kawaguchi Y, Hara M et al. Efficacy and safety of intravenous cyclophosphamide pulse therapy with oral prednisolone in the treatment of interstitial lung disease with systemic sclerosis: 4-year follow-up. Mod Rheumatol. 2011 Jun;21(3):296–301.
Várai G, Earle L, Jimenez SA et al. A pilot study of intermittent intravenous cyclophosphamide for the treatment of systemic sclerosis associated lung disease. J Rheumatol. 1998 Jul;25(7):1325–9.
Van den Hoogen F, Khanna D, Fransen J et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013 Nov;72(11):1747–55.
Fokkens WJ, Lund VJ, Mullol J et al. European Position on Rhinosinusitis and Nasal Polyps 2012. Epidemiology of ARS. Rhinology, 2012; suppl. 23:9–16.