Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in SLE

Cyclophosphamide might possibly be more effective in reducing symptoms of neuropsychiatric involvement in SLE compared with methylprednisolone but the evidence is insufficient.

The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding), and by imprecise results (few patients).

Summary

A Cochrane review included 1 study with 32 subjects. Treatment response, defined as 20% improvement from basal conditions by clinical, serological and specific neurological measures, was found in more patients using cyclophosphamide compared with the methylprednisolone group at 24 months (table ); the number needed to treat for an additional beneficial outcome (NNTB) of treatment response is 3. No statistically significant differences between the groups in damage index measurements (Systemic Lupus International Collaborating Clinics (SLICC)) were found. The median SLE Disease Activity Index (SLEDAI) rating favoured the cyclophosphamide group. Cyclophosphamide use was associated with a reduction in prednisone requirements. All the patients in the cyclophosphamide group had electroencephalographic improvement but there was no statistically significant difference in decrease between groups in the number of monthly seizures. No statistically significant differences in adverse effects, including mortality, were reported between the groups.

Clinical comments

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Ədəbiyyat

1. Fernandes Moça Trevisani V, Castro AA, Ferreira Neves Neto J et al. Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database Syst Rev 2013;(2):CD002265.