Cyclophosphamide pulse therapy followed by azathioprine or methotrexate induces long-term remission in patients with steroid-refractory Crohn's disease.

Abstract

BACKGROUND:

In patients with steroid-refractory Crohn's disease, the therapeutic goal is to achieve both rapid remission and maintenance of clinical response.

AIM:

To evaluate the long-term benefit in patients treated with cyclophosphamide pulse therapy and azathioprine or methotrexate, a combination shown to be effective in a recent pilot study.

METHODS:

Sixteen patients with acute steroid-refractory Crohn's disease participated in a prospective open-labelled uncontrolled pilot study between December 1998 and June 2003. All had a median number of 4 monthly pulses of intravenous cyclophosphamide (750 mg) and were followed until relapse of the disease.

RESULTS:

Thirteen of 16 patients (81%) achieved remission within 8 weeks after two pulses of cyclophosphamide in combination with azathioprine or methotrexate, with a Crohn's Disease Activity Index decrease from 294 to 111 (median). Remission sustained for 19 months (median, range: 1-45). Moreover, eight patients with pyoderma gangrenosum and erythema nodosum who responded to cyclophosphamide have maintained their remission for up to 30 months.

CONCLUSIONS:

In steroid refractory patients with Crohn's disease, cyclophosphamide is highly effective to induce remission. This uncontrolled study indicates that cyclophosphamide-induced remission is long-lasting under standard immunosuppressive therapy.

• Authors: C Schmidt, B M Wittig, C Moser, M Zeitz, A Stallmach
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 24 Issue 2 Pg. 343-50 (Jul 15 2006) ISSN: 0269-2813 [Print] England
• PMID: 16842461 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunosuppressive Agents
• Steroids
• Cyclophosphamide
• Azathioprine
• Methotrexate

Topics

• Adult
• Azathioprine (therapeutic use)
• Crohn Disease (drug therapy)
• Cyclophosphamide (therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Methotrexate (therapeutic use)
• Prospective Studies
• Remission Induction
• Steroids (therapeutic use)
• Treatment Outcome