Advantages of Intravenous Pulse Cyclophosphamide in ANCA-associated Vasculitis Save

Researchers from the Nottingham University Hospitals have analyzed the efficacy and safety of  oral (PO) and intravenous (IV)  cyclophosphamide (CTX) in ANCA-associated vasculitis (AAV) patients and demonstrated a trend for fewer relapses, better 1 year survival and less toxicity with IV CTX.

We aimed to compare risk of death, relapse, neutropenia and infection requiring hospital admission between unselected ANCA-associated vasculitis (AAV) patients according to whether cyclophosphamide induction was by daily oral (PO) or pulse intravenous (IV) route.

They studied 57 newly diagnosed AAV patients treated with PO or IV cyclophosphamide from 3/07 to 6/13 and compared death, relapse, neutropenia and hospitalized infections, after adjusting for age, renal function and other significant confounders.

One-year survival was greater with IV CTX (98.2% vs 86%) compared to PO (HR  PO vs IV = 1.8; 95% CI 0.3–10.6, P = 0.54).

One-year relapse-free survival was higher w/ IV CTX (87.3% vs 80.7% (HR 3.8; 95% CI 0.2–846, P = 0.37).

Toxicities were more likely with PO CTX (compared to IV) in the first 12 months.

• neutropenia (16% PO and 0 IV) (P = 0.003).
• hospitalized infections (28% PO  vs 16% IV) (OR 2.2; 0.6–8.6, P = 0.23).
• there was a trend towards more deaths and admissions with PO cyclophosphamide.

Overall oral administration of CTX induces greater marrow toxicity and more infections.