Contributions
Abstract: EP1672
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Cyclophosphamide(Cy) is used as an induction therapy for aggressive relapsing-remitting multiple sclerosis(RRMS) and possibly for progressive types of the disease(primary or secondary progressive - PP or SP). The aim of this observational study was to identify determinants of disability improvement in patients receiving monthly(MO) infusions of Cy.
Methods: 91 MS patients (57 females and 34 males, mean age: 47.9, range: 26-75, mean duration of disease: 14.2 years, range: 0-46, median Expanded Disability Status Scale-EDSS: 6.0, range: 1.5-8.0),
7 (7.7%) with RRMS, 56 (61.5%) with SPMS, 22 (24.2%) with PPMS and 6 (6.6%) with relapsing progressive MS (RPMS) were included. The median number of MO Cy infusions was 3 (range: 1-21). The median MO Cy dose was 700mg/m2BSA (range: 500-1,500mg). Previous therapy (i.e. none, disease modifying drugs, immunosuppressive drugs or both) and the presence of 1 or more Gd+ lesions before treatment was recorded. Disability improvement(DI) was defined as one point change in EDSS at the time of each patient´s evaluation after the last infusion. Univariate tests (Student´s t-test and chi-square test) and a Cox proportional hazard model was employed to ascertain determinants of improvement with Cy-therapy.
Results: 63 patients (69.2%) were identified with DI. The response rate across MS types was RRMS/RPMS: 69.2%, SPMS: 69.6% and PPMS: 68.2% (p=0.99). Univariate test revealed that gender, age, duration of MS, EDSS at Cy onset, previous therapy and Cy cumulative dose did not affect Cy response. The number of patients with DI was significantly higher in patients with no Gd+ lesions at Cy commencement than patients with at least one Gd+ lesion (77.5% vs. 40%, p=0.003). Absence of Gd+ lesions was significantly related to disability improvement after Cy-therapy(HR: 2.56, 95%CI 1.16-5.66, p=0.02), after controlling for age, gender, duration of disease, EDSS, previous therapy and disease type. Three patients on Cy-therapy developed urinary tract infection.
Conclusions: This study provides evidence for the significant DI of Cy-therapy even in MS patients with less neuroinflammatory types of the disease. Presumably, the ability of Cy to cross blood-brain barrier may account for the neuroprotective properties documented in this study. In an era of ongoing development of newer neuroprotective drugs, older and low cost treatments (i.e. Cy) may still confer significant DI in less neuroinflammatory or progressive types of MS.
Disclosure:
Dr. Maria Anagnostouli has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr Georgios Koutsis has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr. Maria-Eleftheria has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr. Elisavet Andreadou has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr Konstantinos Kilindireas has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
PhDc Artemios Artemiadis: nothing to disclose
Mr. Georgios Karagiorgis nothing to disclose
Mrs Panagiota Dimopoulou nothing to disclose
Mrs Paraskevi Katsika nothing to disclose
Mrs Pinelopi Koutsoudaki nothing to disclose
Abstract: EP1672
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Cyclophosphamide(Cy) is used as an induction therapy for aggressive relapsing-remitting multiple sclerosis(RRMS) and possibly for progressive types of the disease(primary or secondary progressive - PP or SP). The aim of this observational study was to identify determinants of disability improvement in patients receiving monthly(MO) infusions of Cy.
Methods: 91 MS patients (57 females and 34 males, mean age: 47.9, range: 26-75, mean duration of disease: 14.2 years, range: 0-46, median Expanded Disability Status Scale-EDSS: 6.0, range: 1.5-8.0),
7 (7.7%) with RRMS, 56 (61.5%) with SPMS, 22 (24.2%) with PPMS and 6 (6.6%) with relapsing progressive MS (RPMS) were included. The median number of MO Cy infusions was 3 (range: 1-21). The median MO Cy dose was 700mg/m2BSA (range: 500-1,500mg). Previous therapy (i.e. none, disease modifying drugs, immunosuppressive drugs or both) and the presence of 1 or more Gd+ lesions before treatment was recorded. Disability improvement(DI) was defined as one point change in EDSS at the time of each patient´s evaluation after the last infusion. Univariate tests (Student´s t-test and chi-square test) and a Cox proportional hazard model was employed to ascertain determinants of improvement with Cy-therapy.
Results: 63 patients (69.2%) were identified with DI. The response rate across MS types was RRMS/RPMS: 69.2%, SPMS: 69.6% and PPMS: 68.2% (p=0.99). Univariate test revealed that gender, age, duration of MS, EDSS at Cy onset, previous therapy and Cy cumulative dose did not affect Cy response. The number of patients with DI was significantly higher in patients with no Gd+ lesions at Cy commencement than patients with at least one Gd+ lesion (77.5% vs. 40%, p=0.003). Absence of Gd+ lesions was significantly related to disability improvement after Cy-therapy(HR: 2.56, 95%CI 1.16-5.66, p=0.02), after controlling for age, gender, duration of disease, EDSS, previous therapy and disease type. Three patients on Cy-therapy developed urinary tract infection.
Conclusions: This study provides evidence for the significant DI of Cy-therapy even in MS patients with less neuroinflammatory types of the disease. Presumably, the ability of Cy to cross blood-brain barrier may account for the neuroprotective properties documented in this study. In an era of ongoing development of newer neuroprotective drugs, older and low cost treatments (i.e. Cy) may still confer significant DI in less neuroinflammatory or progressive types of MS.
Disclosure:
Dr. Maria Anagnostouli has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr Georgios Koutsis has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr. Maria-Eleftheria has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr. Elisavet Andreadou has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
Dr Konstantinos Kilindireas has received honoraria and research support from all pharmaceutical companies involved in MS therapeutics. Cyclophosphamide is solely avalaible by a national health provider.
PhDc Artemios Artemiadis: nothing to disclose
Mr. Georgios Karagiorgis nothing to disclose
Mrs Panagiota Dimopoulou nothing to disclose
Mrs Paraskevi Katsika nothing to disclose
Mrs Pinelopi Koutsoudaki nothing to disclose