Contributions
Abstract: EP1588
Type: Poster Sessions
Abstract Category: Therapy - Immunomodulation/Immunosuppression
Introduction: Cyclophosphamide (CYP) is an immunosuppressive drug, commonly used in Multiple Sclerosis (MS) in some French MS centres. While this drug seems to be efficient to treat inflammation in Relapsing Remitting (RR) MS, several randomized controlled trials have been conducted in progressive MS but with contradictory results. Here, we analyzed the efficacy and safety of the use of CYP in real life in a French cohort of MS patients.
Methods: All MS patients that had received CYP between 1989 and 2016 in Nantes, were included. Expanded Disability Status Scale (EDSS), relapses, gadolinium enhancing lesions and adverse events were collected.
Results: 222 MS patients were included (115 Secondary Progressive MS, 66 Primary Progressive MS and 41 RRMS). The mean age at baseline was 46,92 years old. Treatment by CYP was started 13 years after the beginning of the disease. 83 patients were naïve of drugs before starting CYP. Mean treatment duration by CYP was of 12.27 months, with a mean cumulative dose of 6.76 g. Mean annualized relapse rate (ARR) decreased from 0,89 (before treatment) to 0,27 at one year and 0,48 at two years (p< 0.0001 for both comparisons vs baseline). Mean EDSS at baseline was 5,60 and increased significantly to 6,01 two years after the beginning of the treatment (p < 0,0001). However, EDSS was stabilized (ns= 53/124) or improved (ni= 31/124) in 67 % patients at 12 months and 50% (ns= 39/117, ni= 20/117) at 24 months. Mean enhancing lesions on Magnetic Resonance Imaging before CYP was 0.64 and decreased to 0.15 one year after the beginning of the treatment (p< 0.05).14 patients stopped CYP for adverse events, 144 for planned arrest, 30 for inefficacy, 8 for others reasons. 94 patients presented some adverse events that were mainly infectious (21,65%), vomiting (16,19%) and asthenia (9,91%).
Conclusion: This immunosuppressive drug seems to be efficient on the inflammatory components of the disease but without major effects on disability progression. A sub group analysis (on the differents forms of MS) will be performed to better understand these results.
Disclosure: Pr David Axel Laplaud : Honoraria and consulting fees from Biogen, Sanofi-Genzyme, Bayer, Novartis, Teva, Merck-Serono, Roche and Medday. Research supports from Biogen, Novartis, Sanofi-Genzyme, Roche and Medday
Dr Sandrine Wiertlewski received consultancy fees, speaker fees, honoraria and clinical research grants (non-personal) from Biogen-Idec, Genzyme, Novartis, Merck, Roche, Sanofi-Aventis and Teva.
Docteur Laure Michel received honoraria as a consultant from Biogen, Teva, Novartis, Roche, Merck and sanofi genzyme
Pacôme Constant Dit Beaufils, Natacha Jousset, Fabienne Lefrere : nothing to disclose
Abstract: EP1588
Type: Poster Sessions
Abstract Category: Therapy - Immunomodulation/Immunosuppression
Introduction: Cyclophosphamide (CYP) is an immunosuppressive drug, commonly used in Multiple Sclerosis (MS) in some French MS centres. While this drug seems to be efficient to treat inflammation in Relapsing Remitting (RR) MS, several randomized controlled trials have been conducted in progressive MS but with contradictory results. Here, we analyzed the efficacy and safety of the use of CYP in real life in a French cohort of MS patients.
Methods: All MS patients that had received CYP between 1989 and 2016 in Nantes, were included. Expanded Disability Status Scale (EDSS), relapses, gadolinium enhancing lesions and adverse events were collected.
Results: 222 MS patients were included (115 Secondary Progressive MS, 66 Primary Progressive MS and 41 RRMS). The mean age at baseline was 46,92 years old. Treatment by CYP was started 13 years after the beginning of the disease. 83 patients were naïve of drugs before starting CYP. Mean treatment duration by CYP was of 12.27 months, with a mean cumulative dose of 6.76 g. Mean annualized relapse rate (ARR) decreased from 0,89 (before treatment) to 0,27 at one year and 0,48 at two years (p< 0.0001 for both comparisons vs baseline). Mean EDSS at baseline was 5,60 and increased significantly to 6,01 two years after the beginning of the treatment (p < 0,0001). However, EDSS was stabilized (ns= 53/124) or improved (ni= 31/124) in 67 % patients at 12 months and 50% (ns= 39/117, ni= 20/117) at 24 months. Mean enhancing lesions on Magnetic Resonance Imaging before CYP was 0.64 and decreased to 0.15 one year after the beginning of the treatment (p< 0.05).14 patients stopped CYP for adverse events, 144 for planned arrest, 30 for inefficacy, 8 for others reasons. 94 patients presented some adverse events that were mainly infectious (21,65%), vomiting (16,19%) and asthenia (9,91%).
Conclusion: This immunosuppressive drug seems to be efficient on the inflammatory components of the disease but without major effects on disability progression. A sub group analysis (on the differents forms of MS) will be performed to better understand these results.
Disclosure: Pr David Axel Laplaud : Honoraria and consulting fees from Biogen, Sanofi-Genzyme, Bayer, Novartis, Teva, Merck-Serono, Roche and Medday. Research supports from Biogen, Novartis, Sanofi-Genzyme, Roche and Medday
Dr Sandrine Wiertlewski received consultancy fees, speaker fees, honoraria and clinical research grants (non-personal) from Biogen-Idec, Genzyme, Novartis, Merck, Roche, Sanofi-Aventis and Teva.
Docteur Laure Michel received honoraria as a consultant from Biogen, Teva, Novartis, Roche, Merck and sanofi genzyme
Pacôme Constant Dit Beaufils, Natacha Jousset, Fabienne Lefrere : nothing to disclose