Combination of cyclophosphamide and interferon-â halts progression in patients with rapidly transitional multiple sclerosis

The eVects of combined treatment with cyclophosphamide (CTX) and interferon-â (IFN-â) are described in selected patients with “rapidly transitional” multiple sclerosis. This form of multiple sclerosis is extremely active with very frequent and severe attacks which produce a dramatic increase on the expanded disability status scale (EDSS). Ten patients with rapidly transitional multiple sclerosis were previously treated with interferon-â, but none benefited by this treatment. Monthly treatment with intravenous CTX, from 500 mg/m to 1500 mg/m to obtain a chronic lymphocytopenia (600/mm to 900/mm) produced a marked and significant reduction in the number of relapses (p<0.0001), disability previously accumulated (p<0.0001), and a reduction of T2 MRI burden of lesion. This particular group of patients benefited by combining cyclophosphamide and IFN-â. The possibility is considered of carrying out further studies to test the eYcacy of the association between the two drugs for patients who are not responsive to IFN-â or other active disease modifying therapies. (J Neurol Neurosurg Psychiatry 2001;71:404–407)