Cyclophosphamide could be a better choice than methotrexate as induction treatment for patients with more severe Takayasu’s arteritis

• Published in: Rheumatology international Vol. 37; no. 12; pp. 2019 - 2026
• Main Authors: Sun, Ying, Ma, Lili, Ma, Lingying, Kong, Xiufang, Chen, Huiyong, Lv, Peng, Lin, Jiang, Liu, Hao, Yan, Yan, Ji, Zongfei, Yang, Chengde, Dai, Shengming, Wan, Weiguo, Zou, Yaohong, Jin, Xuejuan, Jiang, Lindi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Administration, Intravenous; Adult; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Drug Therapy, Combination; Female; Glucocorticoids - administration & dosage; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Magnetic Resonance Angiography; Male; Medicine; Medicine & Public Health; Methotrexate - administration & dosage; Methotrexate - adverse effects; Middle Aged; Observational Research; Prednisone - administration & dosage; Prospective Studies; Remission Induction - methods; Rheumatology; Severity of Illness Index; Takayasu Arteritis - diagnostic imaging; Takayasu Arteritis - drug therapy; Treatment Outcome; Vein & artery diseases; Whole Body Imaging; Cyclophosphamide; Treatment; Takayasu’s arteritis; Methotrexate; Induction
• ISSN: 0172-8172; 1437-160X; 1437-160X
• DOI: 10.1007/s00296-017-3847-6

To assess the effectiveness of cyclophosphamide (CYC) versus methotrexate (MTX) for active Takayasu’s arteritis (TA). The current study was based on a cohort of TA at Zhongshan Hospital, Fudan University. TA was diagnosed using the 1990 American College of Rheumatology criteria. Fifty-eight subjects receiving induction treatment with CYC ( n  = 46) or MTX ( N  = 12) were included in the analysis. Effectiveness and toxicity were assessed in all 58 cases. Clinical remission was defined as: Kerr score reduction to ≤ 1 and glucocorticoids (GC) treatment at a dose of ≤ 0.2 mg/kg/day (≤ 15 mg/day) at the end of the 6th month. At the baseline, the CYC group had higher Kerr scores (60.9% vs. 16.7% at ≥3, p  = 0.044), higher ESR (55 ± 52 vs. 25 ± 22 mm/H, p  = 0.048), ITAS_ESR (12.4 ± 1.7 vs. 9.1 ± 1.1 mg/L, p  = 0.043). The 6-month clinical remission rate was 71.7% vs. 75% in the CYC and MTX group, respectively. In the CYC group, a significant decrease was observed in ESR (55 ± 52 vs. 25 ± 48 mm/H, p  = 0.008), hs-CRP (27 ± 23 vs. 6.9 ± 6.6 mg/L, p  = 0.007), ITAS (11.7 ± 2.2 vs. 7.0 ± 1.5, p  = 0.048), and ITAS_ESR (7.1 ± 2.0 vs. 12.4 ± 1.7, p  = 0.033). However, no significant reductions in these measures were demonstrated in the MTX group. Whole-body contrast enhanced magnetic resonance angiography (MRA) revealed significant radiologic improvement (wall enhancement scores: 4.2 ± 2.3 vs. 10.3 ± 3.8, p  = 0.032) in the CYC group, but not in the MTX group. No severe adverse events occurred in any subject. Cyclophosphamide could be a better choice than methotrexate as induction treatment for patients with more severe Takayasu’s arteritis.