Contributions
Abstract: EP1540
Type: ePoster
Abstract Category: Therapy - disease modifying - Treatment of progressive MS
Background: Despite recent advances in multiple sclerosis (MS) therapeutic options, available treatment options for progressive disease remain limited. Pulse intravenous cyclophosphamide has been reported to be effective in stabilizing or slowing progression in subpopulation of progressive MS patients.
Objective: To assess the efficacy and safety of cyclophosphamide in progressive MS patients followed at a specialized academic MS center in Lebanon.
Methods: A retrospective review of all progressive MS patients treated with intravenous pulse cyclophosphamide therapy at the MS Center between October 2011 and April 2016 was performed. Outcome measures included clinical status at 6 months, 12 months, and at last follow-up visit determined by change in Expanded Disability Status Scale (EDSS), ambulation index, timed 25 foot walk (T25-FW), 9-Hole Peg Test (9-HPT) and Symbol Digit Modalities Test (SDMT) after treatment initiation.
Results: Patients were treated with pulses of cyclophosphamide/methylprednisolone every 4 to 8 weeks. Fourty seven patients were followed-up for a mean period of 12.3 months±8.12. EDSS improved in 19.6% (n=9) and was stable in 45.7% (n=21). The majority of the patients had stable or improved ambulation score after 6 and 12 months of cyclophosphamide treatment (77.8% at 6-month and 64.3% at 12-month) whereas the 500 meter ambulation score worsened in 55.9% of the patients at their last follow-up visit. Similar results were observed for the timed 25-foot walk. The proportion of patients with no new T2 lesions or enhancing lesions decreased from 22% (n=9) at baseline to 10.7% (n=3) on cyclophosphamide therapy. Treatment was discontinued in 70.5% (n=31) of patients due to disease progression in 45.5% (n=20), adverse events in 13.6% (n=6), progression and adverse events in 6.8% (n=3), and fear of chemotherapy in 4.6% (n=2). 37 patients (78.7%) experienced various side effects with nausea and/or vomiting (35.5%), fatigue (19.7%), and infections (15.8%) being the most common. One patient developed hemorrhagic cystitis.
Conclusion: Our cohort showed that cyclophosphamide pulse therapy was effective during the first year of treatment; adverse events were common but lead to discontinuation in 20% of the patients.
Disclosure:
Dr. Yamout reports grants and speaker honoria from Biogen, gMerck -Serono, Novartis, Genzyme, and Bayer, outside the submitted work.
Dr. Khoury reports research grants from Biogen, gMerck -Serono, Novartis, Genzyme, and Bayer, outside the submitted work.
Dr. Tamim has nothing to disclose.
Dr.Zeineddine has nothing to disclose.
Dr.Ghassan has nothing to disclose.
Dr. Taha has nothing to disclose.
Dr.Ayoubi has nothing to disclose.
Mrs. Massouh has nothing to disclose.
Abstract: EP1540
Type: ePoster
Abstract Category: Therapy - disease modifying - Treatment of progressive MS
Background: Despite recent advances in multiple sclerosis (MS) therapeutic options, available treatment options for progressive disease remain limited. Pulse intravenous cyclophosphamide has been reported to be effective in stabilizing or slowing progression in subpopulation of progressive MS patients.
Objective: To assess the efficacy and safety of cyclophosphamide in progressive MS patients followed at a specialized academic MS center in Lebanon.
Methods: A retrospective review of all progressive MS patients treated with intravenous pulse cyclophosphamide therapy at the MS Center between October 2011 and April 2016 was performed. Outcome measures included clinical status at 6 months, 12 months, and at last follow-up visit determined by change in Expanded Disability Status Scale (EDSS), ambulation index, timed 25 foot walk (T25-FW), 9-Hole Peg Test (9-HPT) and Symbol Digit Modalities Test (SDMT) after treatment initiation.
Results: Patients were treated with pulses of cyclophosphamide/methylprednisolone every 4 to 8 weeks. Fourty seven patients were followed-up for a mean period of 12.3 months±8.12. EDSS improved in 19.6% (n=9) and was stable in 45.7% (n=21). The majority of the patients had stable or improved ambulation score after 6 and 12 months of cyclophosphamide treatment (77.8% at 6-month and 64.3% at 12-month) whereas the 500 meter ambulation score worsened in 55.9% of the patients at their last follow-up visit. Similar results were observed for the timed 25-foot walk. The proportion of patients with no new T2 lesions or enhancing lesions decreased from 22% (n=9) at baseline to 10.7% (n=3) on cyclophosphamide therapy. Treatment was discontinued in 70.5% (n=31) of patients due to disease progression in 45.5% (n=20), adverse events in 13.6% (n=6), progression and adverse events in 6.8% (n=3), and fear of chemotherapy in 4.6% (n=2). 37 patients (78.7%) experienced various side effects with nausea and/or vomiting (35.5%), fatigue (19.7%), and infections (15.8%) being the most common. One patient developed hemorrhagic cystitis.
Conclusion: Our cohort showed that cyclophosphamide pulse therapy was effective during the first year of treatment; adverse events were common but lead to discontinuation in 20% of the patients.
Disclosure:
Dr. Yamout reports grants and speaker honoria from Biogen, gMerck -Serono, Novartis, Genzyme, and Bayer, outside the submitted work.
Dr. Khoury reports research grants from Biogen, gMerck -Serono, Novartis, Genzyme, and Bayer, outside the submitted work.
Dr. Tamim has nothing to disclose.
Dr.Zeineddine has nothing to disclose.
Dr.Ghassan has nothing to disclose.
Dr. Taha has nothing to disclose.
Dr.Ayoubi has nothing to disclose.
Mrs. Massouh has nothing to disclose.