Safety and efficacy of intravenous pulse cyclophosphamide in acute steroid refractory inflammatory bowel disease

Stallmach, A.; Wittig, B.M.; Moser, C.; Fischinger, J.; Duchmann, R.; Zeitz, M.
March 2003
Gut;Mar2003, Vol. 52 Issue 3, p377
Academic Journal
Background and aims: One major problem in the management of steroid refractory attacks of patients with inflammatory bowel disease (IBD) is the establishment of a rapidly acting immunosuppressive regimen. Based on its well known efficacy in systemic vasculitis, intravenous cyclophosphamide pulse therapy was used in refractory IBD patients to evaluate both its efficacy and safety. Methods: Between December 1998 and May 2001, seven patients (Crohn's disease, n=5; indeterminate colitis, n=1) with severe steroid refractory IBD (Crohn's disease activity index (CDAI) 264-479 points) received 4-6 cycles of monthly treatment with intravenous cydophosphamide (750 mg) in a prospective uncontrolled pilot study. Results: All patients improved after two intravenous pulses of cyclophosphamide and six of seven patients achieved complete remission (CDAI <150 points). One patient with Crohn's disease of the small and large bowel showed an impressive clinical response but did not enter into remission. Tapering to Iow dose steroids was possible in all responders. Remission was maintained in all patients for 18 months (median) but required a second course of intravenous pulse cyclophosphamide in one patient. The drug was well tolerated except for two episodes of candida oesophagitis. Conclusions: 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.


Related Articles

  • The vasculitis in IBD is associated with the degree of inflammation.  // Inflammatory Bowel Disease Monitor;2010, Vol. 11 Issue 1, p29 

    No abstract available.

  • Chronic Diarrhea in Essential Mixed Cryoglobulinemia: A Manifestation of Visceral Vasculitis? Jones, Michael P.; Pandak, W. Michael; Moxley, George F. // American Journal of Gastroenterology;Apr1991, Vol. 86 Issue 4, p522 

    Gastrointestinal involvement occurs frequently in essential mixed cryoglobulinemia, and most often involves the liver and spleen. Intestinal involvement is much less common and is generally felt to be a late and often catastrophic manifestation of the disease due to severe vasculitis....

  • Crohn's Disease and Acute Leukocytoclastic Vasculitis of Skin. Zlatanic, Jusuf; Fleisher, Mark; Sasson, Michelle; Kim, Peter; Korelitz, Burton I. // American Journal of Gastroenterology;Nov1996, Vol. 91 Issue 11, p2410 

    A 39-yr-old white male with a prolonged history of Crohn's disease presented with worsening diarrhea associated with an increasingly painful rash of both lower extremities as well as left ankle swelling. A skin biopsy revealed an acute leukocytoclastic vasculitis. Intravenous hydrocortisone...

  • Coexistence of vasculitides with Familial Mediterranean Fever. Aksu, Kenan; Keser, Gokhan // Rheumatology International;Oct2011, Vol. 31 Issue 10, p1263 

    Familial Mediterranean fever (FMF) is the most common autoinflammatory disease characterized by recurrent self-limited attacks of fever accompanied with peritonitis, pleuritis, or arthritis. FMF may coexist with various systemic inflammatory diseases including vasculitides, spondyloarthritis,...

  • Arterite de Takayasu e doença de Crohn: uma associação incomum. Konopka, Clóvis; Braun, Stela Karine; Machado, Gabriela // Jornal Vascular Brasileiro;Dec2009, Vol. 8 Issue 4, p355 

    Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with Crohn's disease and...

  • Cytoplasmic Antineutrophil Cytoplasmic Antibody-Positive Vasculitis Associated with Ulcerative Colitis. Weir, Andrew; Taylor-Robinson, Simon D.; Poole, Simon; Pignatelli, Massimo; Walters, Julian F. R.; Calam, John // American Journal of Gastroenterology;Mar1997, Vol. 92 Issue 3, p506 

    The case of a man with poorly controlled ulcerative colitis, who developed a cytoplasmic antineutrophil cytoplasmic antibody-positive systemic vasculitis, causing small bowel infarction is reported. Antineutrophil cytoplasmic antibodies occur in 50-70% of patients with ulcerative colitis, but...

  • Inflammatory bowel disease patients' skin needs attention. Oakley, Amanda // New Zealand Doctor;7/16/2014, p31 

    The article offers information on several skin diseases associated with inflammatory bowel disease (IBD). Among the skin diseases discussed include local skin diseases such as aphthous ulcers, neutrophilic dermatoses such as Pyoderma gangrenosum, Sweet syndrome, and pyodermatitis vegetans, and...

  • Cutaneous granulomatous vasculitis: presenting feature of Crohn's disease. Slater, D. N.; Wailer, P. C.; Reilly, G. // Journal of the Royal Society of Medicine;Jul1985, Vol. 78 Issue 7, p589 

    The article discusses the case of a patient who is suffering from cutaneous granulomatous vasculitis which presents symptoms of Crohn's disease. The 51-year-old patient was diagnosed of granolumatous vasculitis due to abdominal symptoms and ankle ulcers yet, it was only after 9 years later that...

  • Appropriateness of antineutrophil cytoplasmic antibody testing in a tertiary hospital. Robinson, P. C.; Steele, R. H. // Journal of Clinical Pathology;Aug2009, Vol. 62 Issue 8, p743 

    AIMS: To determine whether indications for ordering antineutrophil cytoplasmic antibodies (ANCA) meet the 1999 guidelines proposed for ANCA testing; and to examine the test characteristics of the ANCA test. METHODS: The indications for all ANCA tests over a two-year period were assessed and...


Read the Article


Sign out of this library

Other Topics