Monthly Intravenous Pulse Cyclophosphamide And Methylprednisolone For Systemic Scleroderma

Objective:To analysis the efficacy and safety of monthly intravenous pulses of cyclophosphamide (IVCYC) and methylprednisolone (MP) in patients with systemic scleroderma (SSc).Methods:34systemic scleroderma patients from the inpatients and outpatients of Zhongshan Hospital from January2008to December2012were involved in the study. The trial group (14consecutive patients with SSc and lung involvement were treated with6pulses of IVCYC (800mg or600mg) and MP monthly; and the control group (20cases with SSc with no lung involvement or limited lung involvement, given only MP and other conventional medication). The clinical indexes were observed and compared with all the patients at baseline and after one treatment course of6months. Evaluate the change of lung function test, High Resolution CT(HRCT), Modified Rodnan skin scores, pulmonary artery systolic pressure measuring by Doppler echo cardiographic and drug reaction. The data of results were analyzed by SPSS18.0software.Results:1. A total of14patients were recruited in trial group.2(14%) of them were male and12(86%) were female. Their age ranged from21to67years with an average of46.29±12.86. While a total of20patients were recruited in the control group.4(20%) of them were male and12(80%) were female. Their age ranged from22to72years with an average of43.85+16.96. There was no significant difference between the two groups of sex and average age.2. Before treatment, there was no significant difference between the two groups of each clinical indexes (P>0.05).3. Results in both groups, improvement was seen in each clinical index after6-month of treatment. It showed that whether or not in combination with cyclophosphamide treatment programs had a certain effect.4. There was significant difference in the improvement of clinical indexes of FVC, FEVi, TCL,DLCO, HRCT scores and modified Rodnan skin scores in the trial group after 6-month treatment, except the pulmonary artery systolic pressure.5. However, there was no significant difference in the improvement of the control group after6-month treatment (P>0.05).6. Except the pulmonary artery systolic pressure, improvement of the indicators in the trial group was significantly greater than that of the control group (P<0.01).7. The treatment was safe and well tolerated. In6-month treatment, one case in the trial group had gastrointestinal reactions of vomiting, and two cases had weakness. But the symptoms disappeared soon after rest and symptomatic treatment.Conclusion:IVCYC combined with MP in the treatment of SSc treatment is better in improving the clinical indexes compared to those with MP therapy. This IVCYC regimen is more effective in improving the SSc patient’s condition and alleviating disease progression.