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Comparison of safety, efficacy and cost between oral pulse cyclophosphamide versus intravenous cyclophosphamide pulse therapy in severe systemic lupus erythematosus
Author(s) -
Padiyar Shivraj,
Arya Suvrat,
Surin Ajit,
Viswanath Vishad,
Danda Debashish
Publication year - 2020
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13823
Subject(s) - medicine , cyclophosphamide , interquartile range , adverse effect , systemic lupus erythematosus , gastroenterology , surgery , chemotherapy , disease
Objectives The aim of this study is to compare efficacy, toxicity and cost between oral and intravenous cyclophosphamide (CYC) pulse therapy in inducing remission (Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] <3) in severe SLE. Methods We retrospectively checked the hospital records of patients between the years 2000 and 2018, who had been administered oral cyclophosphamide pulse and intravenous (IV) cyclophosphamide pulse. SLEDAI at baseline and after 6 months of therapy were noted. The statistical analysis was done using Mann‐Whitney U test. The cost was also calculated. Results We included 45 patients in this study, 21 in the oral pulse group and 24 in the IV group. The median age of patients in the oral and IV groups were 29 (interquartile range [IQR] 22‐37) and 26 (IQR 19.25‐0.75) years respectively. Median SLEDAI at baseline was comparable between the 2 groups (oral 18.0 [IQR 15.0‐26.0]; IV 14.5 [IQR 11.0‐20.0] P = .151). At the end of 6 months of treatment, it was 0.0 (IQR 0.0‐4.0) in the oral group, as against 2.0 (IQR 0.0‐5.5) in IV group ( P = .676). There was no major adverse event in either group. Oral cyclophosphamide pulse therapy was more economical as compared to IV cyclophosphamide [630 Indian National rupees( INR)/ 8.85 US dollars(USD) in the IV arm and 50 INR/0.7 USD in the oral arm] ( P < .001). Conclusion This study concludes that oral cyclophosphamide pulse therapy is an economical option and there was no difference in efficacy and safety between oral cyclophosphamide pulse therapy and IV pulse cyclophosphamide therapy.