A major problem in the management of steroid refractory inflammatory bowel disease (IBD) is the establishment of a rapidly acting immunosuppressive regimen.
In this uncontrolled pilot study, researchers evaluated the safety and efficacy of intravenous cyclophosphamide pulse therapy in refractory IBD patients. The team’s results are published in the March issue of Gut.
The team assessed 7 patients with severe steroid refractory IBD. Patients received 4 to 6 cycles of monthly treatment with intravenous cyclophosphamide (750 mg), between 1998 and 2001.
The team found that all patients improved after 2 intravenous pulses of cyclophosphamide.
|6 of the 7 patients achieved complete remission.|
Overall, 6 of the 7 patients achieved complete remission.
However, 1 patient with Crohn’s disease of the small and large bowel showed an impressive clinical response, but did not enter into remission.
The team found that tapering to low dose steroids was possible in all responders.
Remission was maintained in all patients for a median of 18 months, however, a second course of intravenous pulse cyclophosphamide was required in 1 patient.
Furthermore, the drug was well tolerated, except for 2 episodes of candida esophagitis.
Dr Stallmach’s team concluded, “Intravenous pulse cyclophosphamide may be a safe and effective treatment in patients with severe IBD unresponsive to steroid treatment and merits evaluation in a controlled trial”.