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Cyclophosphamide Therapy for Multiple Sclerosis

  • Chapter
Multiple Sclerosis

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Cyclophosphamide has long been a widely used alkylating agent in the treatment of malignancies, notably hematologic malignancies and, despite its long history, continues to find new uses in immune-mediated nonmalignant processes. Although cyclophosphamide has been studied as a treatment for multiple sclerosis (MS) for the past 30 years, it is only after successful trials of mitoxantrone with improved designs employing magnetic resonance imaging (MRI) as a surrogate marker that clinical researchers have become highly confident of the use of this class of drugs. Trial results suggest that it is efficacious in cases of worsening MS that have an inflammatory component as evidenced by relapses and/or gadolinium (Gd)-enhancing lesions on MRI or in patients in earlier stages of progression. There is no evidence of efficacy in primary-progressive (PPMS) or later secondary-progressive MS (SPMS). Although they are usually considered a general immunosuppressive agent, immunologic studies indicate that proliferating myelin-specific T-cells may be preferentially eliminated in MS. Side effects include nausea, alopecia, infertility, bladder toxicity, and risk of malignancy. Cyclophosphamide is usually given as every 4- to 8-week outpatient intravenous (IV) pulse therapy with or without corticosteroids and is usually well tolerated. Cyclophosphamide is recommended for patients with MS whose disease is not controlled by first-line agents and those with rapid worsening.

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  1. Department of Neurology, Multiple Sclerosis Center, Beth Israel-Deaconess Medical Center and Harvard Medical School, Boston, MA

    Derek R. Smith MD

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  1. Multiple Sclerosis Center, Department of Neurology, University of California, Irvine, CA

    Michael J. Olek DO

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© 2005 Humana Press Inc., Totowa, NJ

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Smith, D.R. (2005). Cyclophosphamide Therapy for Multiple Sclerosis. In: Olek, M.J. (eds) Multiple Sclerosis. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-855-2:171

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  • DOI: https://doi.org/10.1385/1-59259-855-2:171

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