الفهرس 
Multiple sclerosis phenotypes and relapsesOnly 14 pages are availabe for public view
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Abstract
Background:
Cyclophosphamide (CYC) is an alkylating agent produces immunosuppression and an anti-inflammatory immune deviation. It is capable of penetrating the blood brain barrier and central nervous system (CNS) parenchyma. CYC used extensively in treating aggressive and rapidly progressive forms of multiple sclerosis (MS), with mixed results.
Objective:
The aim of this open study was to determine the effect of cyclophosphamide therapy given to active form of relapsing-remitting MS (RRMS) patients for better control of clinical disease activity regarding relapse rate, disease progression, drug safety and radiological outcome.
Methods:
We studied 69 patients with active RRMS divided into 3 arms (groups). First arm received monthly pulse doses of CYC plus 1gm methylprednisolone for 12 months to induce leukopenia of 2000-3000/mm3 and/or lymphopenia of 800/mm3. Second arm received interferon beta 1-A 44 IU subcutaneous three times weekly. Third arm received monthly pulse 1gm methylprednisolone. All patients received treatment for 12 months.
Main Outcome Measures:
The primary outcome measure was annual relapse reduction with stabilization of disease progression (measured by Expanded Disability Status Scale {EDSS}) and decrease MRI activity as secondary outcome measures compared to pretreatment state.
Results:
At 12th month of therapy, CYC produced a marked and significant reduction in the number of relapses (p<0.001), disability previously accumulated (p<0.001) and a reduction of gadolinium enhancing lesions (p<0.004) compared to pretreatment baseline state. Also, CYC showed significant reduction of relapse rate and EDSS compared to monthly solumedrol. There was no significant difference between CYC and interferon beta as regards relapse reduction and EDSS. There was no significant difference between groups as regards new T2 lesions or Gd enhancing lesion at follow up.
Conclusion:
CYC showed significant clinical and radiological beneficial effect on controlling RRMS activity.