A to Z of MS
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A to Z of MS Cyclophosphamide (Endoxana, Revimmune)
Product name
Endoxana
Cyclophosphamide is a potent immunosuppressive drug that is frequently used in combination chemotherapy regimens to treat leukaemia and other forms of cancer.
Although not a first line treatment, cyclophosphamide has been used for many years in people with MS who have failed to respond to other therapies and are experiencing frequent relapses with rapid progression. Research has shown only limited benefit at best from the treatment and the side effects mean that it is rarely used.
The NICE Guideline states that this treatment should not be used in multiple sclerosis as research evidence does not show any beneficial effect on the course of the condition.
How cyclophosphamide is given
Cyclophosphamide can be taken orally as tablets, as an injection into a vein (intravenously), or by drip (intravenous infusion).
Side effects and contraindications
In the short-term, side effects can include hair loss, nausea, infertility, bladder irritation and risk of infection.
Reference
La Mantia L, et al.
Cyclophosphamide for multiple sclerosis.
Cochrane database of systematic reviews 2007;(1):CD002819.
abstract
Patient Information Leaflet
- Cyclophosphamide (EMC website)
Revimmune
Revimmune is the brand name of a new application of cyclophosphamide as an ultra-high intensity, short-course intravenous infusion.
Revimmune works by eliminating the cells responsible for the immune attack that is seen in multiple sclerosis, thereby allowing the body's immune system to 'reboot'.
Revimmune is in development for a variety of autoimmune diseases, and preliminary findings suggest it holds potential as a treatment option for people with severe refractory MS - MS that is not responding to other treatments. However, further studies are necessary to determine the most appropriate patients for this treatment.
References
Schwartzman RJ, et al.
High-dose cyclophosphamide in the treatment of multiple sclerosis.
CNS Neuroscience & Therapeutics 2009;15(2):118-127.
abstract
Gladstone DE, et al.
High-dose cyclophosphamide for moderate to severe refractory multiple sclerosis.
Archives of Neurology 2006;63(10):1388-1393.
abstract
Krishnan C, et al.
Reduction of disease activity and disability with high-dose cyclophosphamide in patients with aggressive multiple sclerosis.
Archives of Neurology 2008;65(8):1044-1051.
abstract