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Cyclophosphamide versus methylprednisolone for lupus

Fernandes Moça Trevisani V, Castro AA, Ferreira Neves Neto J, Atallah ÁN
Published Online: 
28 February 2013

Does cyclophosphamide work to treat central nervous system lupus (neuropsychiatric lupus)?

Researchers in The Cochrane Collaboration conducted a review of the effect of cyclophosphamide for people with central nervous system lupus compared to the usual treatment of methylprednisolone. After searching for all relevant studies, they found one study with 32 people. The study compared people who took cyclophosphamide by IV (intravenous or through a vein) to people who took steroids (methylprednisolone by IV). All people took steroid pills (prednisone) at the beginning of the study and the amount was decreased over the study. The study lasted two years.

Their findings are summarised below:

In people with central nervous system lupus:

- We are uncertain whether cyclophosphamide improves signs and symptoms or disease activity compared to methylprednisolone.

- No differences between the two groups were found in tissue or organ damage, or in the number of monthly seizures, but this may have happened by chance.

- After six months of treatment, people who took cyclophosphamide took fewer prednisone pills than people who took methylprednisolone.

- And at the end of two years, more people who took cyclophosphamide stayed on their treatment than people who took methylprednisolone.

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Side effects, such as infections, high blood sugar and high blood pressure, pancreas problems and death occurred about the same amount in people who took cyclophosphamide or methylprednisolone.

What is central nervous system lupus and how could cyclophosphamide help? 

Systemic lupus erythematosus (SLE) is a disease in which the body's immune system attacks the body. In CNS lupus (central nervous system lupus) the body may have attacked and damaged the cells in the brain and spine. This damage may cause a person to have convulsions/seizures, chronic headaches, confusion and psychosis. Drugs such as corticosteroids (prednisone or methylprednisolone) are usually used for lupus to decrease inflammation and control the immune system. Immunosuppressive agents or cytotoxics such as cyclophosphamide (CTX or Cytoxan) may also be used.

What happens to people with central nervous system lupus who take cyclophosphamide compared to methylprednisolone?

- 49 more people who took cyclophosphamide improved than people who took methylprednisolone.

- 95 out of 100 people had at least a 20% improvement in symptoms with cyclophosphamide.

- 46 out of 100 people had at least a 20% improvement in symptoms with methylprednisolone.

This record should be cited as: 
Fernandes Moça Trevisani V, Castro AA, Ferreira Neves Neto J, Atallah ÁN. Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD002265. DOI: 10.1002/14651858.CD002265.pub3
Assessed as up to date: 
16 November 2012
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