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Therapeutic efficacy of combined glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis for skin sclerosis in diffuse systemic sclerosis.
- Source :
-
Medicine [Medicine (Baltimore)] 2020 Mar; Vol. 99 (10), pp. e19301. - Publication Year :
- 2020
-
Abstract
- We treated skin sclerosis with triple therapy consisting of a glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis. The objective of this study was to analyze its effectiveness in a case series of patients who received triple therapy.We enrolled 8 patients with diffuse cutaneous systemic sclerosis (dcSSc) who received triple therapy at our hospital from 2008 to 2016. We analyzed the mean change in the modified Rodnan skin score (mRSS), percentage of the predicted forced vital capacity (%FVC), percentage of the predicted carbon monoxide diffusing capacity (%DLCO), and serum KL-6 levels from baseline to follow-up.All patients were treated with an intermediate dose of oral prednisolone (30.6 ± 2.1 mg/day) initially. The mean cumulative dose of intravenous cyclophosphamide was 1.4 ± 0.2 g. The mean mRSS decreased significantly at follow-up compared with that at baseline (27.0 ± 3.3 vs 15.8 ± 3.5; P = .03). At the end of the treatment, the mean %FVC and %DLCO were improved moderately, although the differences were not significant. The serum KL-6 levels decreased from 578.9 ± 146.5 to 205.3 ± 43.1 U/ml (P = .02). No significant correlation was found between the change in mRSS or disease duration and the initial skin score severity.Triple therapy may improve skin sclerosis, with effectiveness equal or superior to other reported treatments. This preliminary case series demonstrates the potential of triple therapy for treating dcSSc. However, prospective studies with long-term follow-up should be performed to assess its role.
- Subjects :
- Administration, Oral
Aged
Combined Modality Therapy
Female
Humans
Infusions, Intravenous
Male
Middle Aged
Mucin-1 blood
Pulmonary Diffusing Capacity
Retrospective Studies
Scleroderma, Diffuse drug therapy
Scleroderma, Diffuse physiopathology
Treatment Outcome
Vital Capacity
Cyclophosphamide therapeutic use
Glucocorticoids therapeutic use
Immunosuppressive Agents therapeutic use
Plasmapheresis
Prednisolone therapeutic use
Scleroderma, Diffuse therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 99
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 32150064
- Full Text :
- https://doi.org/10.1097/MD.0000000000019301