Role of intravenous cyclophosphamide in the treatment of severe neuropsychiatric systemic lupus erythematosus
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Neuropsychiatric lupus erythematosus: Focusing on autoantibodies
2022, Journal of AutoimmunityCitation Excerpt :Notably, evidence from a small, randomized controlled clinical trial (RCT) [208] and other pilot studies [209] in NPLE have illustrated that CYC is more effective in reducing NPLE symptoms compared with methylprednisolone [210]. Moreover, several observational studies have described the effectiveness of low-dose intravenous CYC (200–400 mg/m2/week or 500 mg/m2/month) combined with glucocorticoids in NPLE [209,211]. Favorable responses to CYC were observed in some rare NP events of NPLE, including peripheral neuropathies [208], PRES [212,213], isolated optic neuritis [214], and CIDP [211,212].
Autoimmune Neurologic Emergencies
2021, Neurologic ClinicsCitation Excerpt :High-dose corticosteroids followed by a steroid-sparing agent such as cyclophosphamide, mycophenolate mofetil, or azathioprine is traditionally considered. Emerging therapies involve anti-CD20 monoclonal antibodies.88,89 Thromboembolic events in the form of arterial and venous thrombosis are present in 20% of NPSLE cases and are strongly correlated with antiphospholipid (aPL) antibodies and lupus anticoagulant.90
Management of inflammatory neurologic and psychiatric manifestations of systemic lupus erythematosus: A systematic review
2021, Seminars in Arthritis and RheumatismCitation Excerpt :This is based on consistent positive results from numerous studies (sixteen of seventeen), including two randomised trials that showed superiority of IV CYC to corticosteroid therapy used alone [26,27]. Limited data also support favourable outcomes for low dose cyclophosphamide regimens in NPSLE [27,35,36,39]. Regarding subgroup data for different manifestations of NPSLE, there is limited evidence to support the use of cyclophosphamide in the treatment of lupus myelitis [34,37,40–42,76,77,94]; however, the proportion of responders is similar to that seen in studies using IV corticosteroids alone for this condition.
Treatment of autoimmune disease: Established therapies
2019, The Autoimmune DiseasesImmunosuppressive drug therapy
2018, Dubois' Lupus Erythematosus and Related SyndromesBroad Concepts in Management of Systemic Lupus Erythematosus
2017, Mayo Clinic ProceedingsCitation Excerpt :The dose and route used have been variable; Mok et al73 used a combination of prednisone and oral Cy (1-2 mg/kg for 6 months) followed by azathioprine maintenance and reported complete response in all 13 patients. A retrospective review71 of use of IVCy monthly (dose, 250-1000 mg/m2) in 31 patients reported response in 61% of patients. In patients with mild manifestations, improvement was seen as early as 4 days but on average 4 monthly IVCy infusions (range, 2-9 months) were required for response.