Vol.21 No.3

Original Article

Efficacy and safety of intravenous cyclophosphamide pulse therapy with oral prednisolone in the treatment of interstitial lung disease with systemic sclerosis: 4-year follow-up

Authors

Akiko Tochimoto¹ , Yasushi Kawaguchi¹ , Masako Hara¹ , Mutsuto Tateishi¹ , Chikako Fukasawa¹ , Kae Takagi¹ , Emi Nishimagi¹ , Yuko Ota¹ , Yasuhiro Katsumata¹ , Takahisa Gono¹ , Eiichi Tanaka¹ , Hisashi Yamanaka¹

Received:

12 August 2010

Accepted:

29 November 2010

Published online:

15 January 2011

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Abstract

Interstitial lung disease (ILD) is a noteworthy condition in the treatment of systemic sclerosis (SSc) because of its associated mortality and morbidity; however, the efficacy of various treatments for ILD has been controversial in previous reports. In this study, we examined the efficacy and safety of intravenous cyclophosphamide (IVCY) pulse therapy with prednisolone (PSL) for the treatment of ILD with SSc. A total of 121 patients with SSc were screened and evaluated for ILD, using high-resolution computed tomography of the chest, pulmonary function testing, and bronchoalveolar lavage. Thirteen patients with active ILD were enrolled in this study. The treatment protocol for ILD was 0.4 g/m2 of body surface area of IVCY monthly plus 0.8 mg/kg of body weight of PSL daily. Two to six doses of IVCY were administered, depending on the remission of ILD. Initial PSL doses were maintained for a month and then gradually tapered to 10 mg daily. An activity index of ILD showed improvements in all patients in the 12 months after the initial intervention; however, four patients experienced recurrence of ILD after 24 months, and one additional patient had recurrence of ILD after 36 months. Seven patients reached the 48-month point with no recurrence of ILD. This long observational study for 48 months showed the efficacy of IVCY with PSL for active alveolitis in the first year. However, because five patients had recurrence of ILD more than 1 year after the treatment, it would be necessary to consider maintenance therapy for ILD beyond 1 year.

Key words

Systemic sclerosis - Cyclophosphamide - Prednisolone - Interstitial lung disease