A multicenter, prospective, randomized, double-blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma

被引:498
作者
Hoyles, Rachel K.
Ellis, Ross W.
Wellsbury, Jessica
Lees, Belinda
Newlands, Pauline
Goh, Nicole S. L.
Roberts, Christopher
Desai, Sujal
Herrick, Ariane L.
McHugh, Neil J.
Foley, Noeleen M.
Pearson, Stanley B.
Emery, Paul
Veale, Douglas J.
Denton, Christopher P.
Wells, Athol U.
Black, Carol M.
du Bois, Roland M.
机构
[1] Royal Brompton Hosp, Interstitial Lung Dis Unit, London SW3 6NP, England
[2] Univ London Imperial Coll Sci & Technol, London, England
[3] Univ Manchester, Manchester, Lancs, England
[4] Kings Coll London, London WC2R 2LS, England
[5] Hope Hosp, Salford M6 8HD, Lancs, England
[6] Royal Natl Hosp Rheumat Dis, Bath BA1 1RL, Avon, England
[7] Royal United Hosp, Bath BA1 3NG, Avon, England
[8] Gen Infirm, Leeds LS1 3EX, W Yorkshire, England
[9] Royal Free Hosp, London NW3 2QG, England
来源
ARTHRITIS AND RHEUMATISM | 2006年 / 54卷 / 12期
关键词
D O I
10.1002/art.22204
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. The lack of randomized controlled trials (RCTs) in pulmonary fibrosis in systemic sclerosis (SSc) has hampered an evidence-based approach to treatment. This RCT was undertaken to investigate the effects of intravenous (IV) cyclophosphamide (CYC) followed by azathioprine (AZA) treatment in pulmonary fibrosis in SSc. Methods. Forty-five patients were randomized to receive low-dose prednisolone and 6 infusions (monthly) of CYC followed by oral AZA, or placebo. Primary outcome measures were change in percent predicted forced vital capacity (FVC) and change in single-breath diffusing capacity for carbon monoxide (DLco). Secondary outcome measures included changes in appearance on high-resolution computed tomography and dyspnea scores. An intent-to-treat statistical analysis was performed. Results. At baseline, there were no significant group differences in factors linked to outcome, including severity of pulmonary fibrosis and autoantibody status. Sixty-two percent of the patients completed the first year of treatment. Withdrawals included 9 patients (6 from the placebo group) with significant decline in lung function, 2 with treatment side effects (both from the active treatment group), and 6 with non-trial-related comorbidity. No hemorrhagic cystitis or bone marrow suppression was observed. Estimation of the relative treatment effect (active treatment versus placebo) adjusted for baseline FVC and treatment center revealed a favorable outcome for FVC of 4.19%; this between-group difference showed a trend toward statistical significance (P = 0.08). No improvements in DLco or secondary outcome measures were identified. Conclusion. This trial did not demonstrate significant improvement in the primary or secondary end points in the active treatment group versus the group receiving placebo. However, for FVC there was a trend toward statistical significance between the 2 groups. This suggests that treatment of pulmonary fibrosis in SSc with low-dose prednisolone and IV CYC followed by AZA stabilizes lung function in a subset of patients with the disease. Therapy was well tolerated with no increase in serious adverse events.
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收藏
页码:3962 / 3970
页数:9
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