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

  • Observational Research
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Abstract

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.

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Author notes

  1. Ying Sun and Lili Ma contributed equally to this study.

Authors and Affiliations

  1. Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Ying Sun, Lili Ma, Lingying Ma, Xiufang Kong, Huiyong Chen, Yan Yan, Zongfei Ji & Lindi Jiang

  2. Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Peng Lv, Jiang Lin & Hao Liu

  3. Department of Rheumatology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, People’s Republic of China

    Chengde Yang

  4. Department of Rheumatology, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China

    Shengming Dai

  5. Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China

    Weiguo Wan

  6. Department of Rheumatology, People’s Hospital, Wuxi, Jiangsu, People’s Republic of China

    Yaohong Zou

  7. Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China

    Xuejuan Jin

Authors
  1. Ying Sun
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  2. Lili Ma
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  3. Lingying Ma
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  6. Peng Lv
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  7. Jiang Lin
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  8. Hao Liu
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  9. Yan Yan
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  11. Chengde Yang
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  12. Shengming Dai
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  13. Weiguo Wan
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  14. Yaohong Zou
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  15. Xuejuan Jin
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  16. Lindi Jiang
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Corresponding author

Correspondence to Lindi Jiang.

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Conflict of interest

Ying Sun, Lili Ma, Lingying Ma, Xiufang Kong, Peng Lv, Jiang Lin, Hao Liu, Yan Yan, Zongfei Ji, Chengde Yang, Shengming Dai, Weiguo Wan, Yaohong Zou, Xuejuan Jin, Lindi Jiang declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sun, Y., Ma, L., Ma, L. et al. Cyclophosphamide could be a better choice than methotrexate as induction treatment for patients with more severe Takayasu’s arteritis. Rheumatol Int 37, 2019–2026 (2017). https://doi.org/10.1007/s00296-017-3847-6

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  • DOI: https://doi.org/10.1007/s00296-017-3847-6

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