Elsevier

The Lancet

Volume 337, Issue 8756, 22 June 1991, Pages 1540-1541
The Lancet

LETTERS to the EDITOR
Cyclophosphamide and plasma exchange in multiple sclerosis

https://doi.org/10.1016/0140-6736(91)93226-YGet rights and content

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    In modern practice, cyclophosphamide is typically used either as a high-dose induction therapy for fulminant MS or as booster administered every 1 to 3 months.18,19 There has been great debate in the literature about the merits of cyclophosphamide administration in MS, with the main North American trials producing divergent results, likely related to the clinical characteristics of the enrolled patients.18–23 An early unblinded randomized controlled trial (RCT) of 60 patients with chronic progressive MS (CPMS) compared cyclophosphamide induction and adrenocorticotropic hormone (ACTH); oral cyclophosphamide, plasma exchange, and ACTH; and ACTH alone.24

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    This study was randomized, placebo controlled, and single masked and included a third treatment group that received plasma exchange with oral cyclophosphamide and prednisone. The failure of the Kaiser and Canadian studies to find a benefit of cyclophosphamide therapy led to controversy in the literature over its use; this debate occurred before our current understanding of anti-inflammatory therapy in MS and the use of MRI to measure inflammatory lesions with contrast-enhanced images [9,19,28–30]. A strict comparison of the trials is impractical because of differing trial designs, patient selection, and treatment regimens.

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