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Cyclophosphamide Therapy of Peripheral Uveitis

Cyclophosphamide Therapy of Peripheral Uveitis Abstract The effectiveness of the cytotoxic drug, cyclophosphamide, has been evaluated in 16 patients with refractory uveitis. Clinically significant suppression of inflammation occurred in nine of nine patients with peripheral uveitis. Results were less predictable in other forms of uveitis. Toxic side effects of cyclophosphamide were less than those reported with mercaptopurine and other metabolic inhibitors or those associated with long-term high dosage systemic steroid therapy. Combined steroid and cyclophosphamide therapy was most effective in suppressing inflammation. Cyclophosphamide decreased the risk of adverse effects of hypertension and diabetes in patients on prolonged steroid therapy. Lymphopenia with or without leukopenia correlated best with control of ocular inflammation. Cyclophosphamide is a potentially useful drug in the care of patients with significant autoallergic disease. References 1. Wong, V.G., and Hersh, E.M.: Methotrexate in the Therapy of Cyclitis , Trans Amer Acad Ophthal Otolaryng 69:279-292 ( (March-April) ) 1965. 2. Newell, F.K., and Krill, A.E.: Treatment of Uveitis With Azathioprine (Imuran) , Trans Ophthal Soc UK 87:499-510 ( (April) ) 1967. 3. Newell, F.W.; Krill, A.E.; and Thompson, A.: The Treatment of Uveitis With 6-Mercaptopurine , Amer J Ophthal 61:1250-1255 ( (May) ) 1966. 4. Turk, J.L., and Stone, S.H.: " Implications of the Cellular Changes in Lymph During the Development and Inhibition of Delayed Hypersensitivity , in Amos, D.B. and Koprowski, H. (eds.): Cell Bound Antibodies , Philadelphia: Wistar Institute Press, 1963, pp 51-60. 5. Turk, J.L.: " The Effect of Immunosuppressive Drugs on Cellular Changes After Antigenic Stimulation ," In Mihich, E. (ed.): Immunity, Cancer and Chemotherapy , New York: Academic Press, Inc., 1967 pp 2-16. 6. Miller, J.J., and Cole, L.J.: Resistance of Long-Lived Lymphocytes and Plasma Cells in Rat Lymph Nodes to Treatment With Prednisone, Cyclophosphamide, 6-Mercaptopurine and Actinomycin D , J Exp Med 126:109-125 ( (July) ) 1967.Crossref 7. Fahey, J.L., and McKelvey, E.M.: Quantitative Determination of Serum Immunoglobulins in Antibody-Agar Plates , J Immun 94:84-90 ( (Jan) ) 1965. 8. Buckley, C.E.; Nagaya, H.; and Sieker, H.O.: Altered Immunologic Activity in Sarcoidosis , Ann Intern Med 64:508-520 ( (March) ) 1966.Crossref 9. Nelson, Jr., R.A.: " The Role of Complement in Immune Phenomena ," in Zweifach, B.W.; Grant, L.; and McCluskey, R.T. (eds.): The Inflammatory Process , New York: Academic Press, Inc., 1965, pp 819-869. 10. Beauregard, W.G.; Webb, C.H.; and Smith, E.: Perisistent Eosinophilia Following Accidental Ingestion of Chloroambucil , J Louisiana Med Soc 117:104-109 ( (April) ) 1965. 11. Hitchings, G.H., and Elion, G.B.: Chemical Suppression of the Immune Response , Pharmacol Rev 15:365-405 ( (June) ) 1963. 12. Levin, R.H.; Landy, M.; and Frei, E.: The Effect of 6-Mercaptopurine on Immune Response in Man , New Eng J Med 271:16-22 ( (July) ) 1964.Crossref 13. Rogentine, Jr., G.N., et al: Metabolism of Human Immunoglobulin D (IgD) , J Clin Invest 45: 1467-1478 ( (Sept) ) 1966.Crossref 14. Murray, E.S.; O'Connor, J.M.; and Gaon, J.A.: Serologic Studies of Primary Epidemic Typhus to Recrudescent Typhus (Brill-Zinsser Disease): II. Differences in Immunoelectrophoretic Patterns, Response to 2-Mercaptoethanol and Relationships to 19 S and 7 S Antibodies , J Immun 94:734-740 ( (May) ) 1965. 15. Whitehouse, A.C., et al: Macroglobulinemia and Vasculitis in Sjogren's Syndrome: Experimental Observations Relating to the Pathogenesis , Amer J Med 43:609-619 ( (Oct) ) 1967.Crossref 16. Sahair, K., and Schwartz, R.S.: The Immunoglobulin Sequence: I. Arrest by 6-Mercaptopurine and Restitution by Antibody, Antigen or Splenectomy , J Immun 95:345-354 ( (Aug) ) 1965. 17. Schwartz, R.S.: " Alteration of Immunity by Antimetabolites ," in Mihich, E. (ed.): Immunity, Cancer and Chemotherapy , New York: Academic Press, Inc., 1967, pp 203-209. 18. Paterson, P.Y.; Hanson, M.A.; and Gerner, E.W.: Cyclophosphamide Inhibition of Experimental Allergic Encephalomyelitis in Wistar Rats , Proc Soc Exp Biol Med 124:928-932 ( (March) ) 1967.Crossref 19. Brock, N.: Pharmacologic Characterization of Cyclophosphamide (NSC-26271) and Cyclophosphamide Metabolites , Cancer Chemother Rep 51:315-325 ( (Oct) ) 1967. 20. Chaube, S.; Kury, G.; and Murphy, M.L.: Teratogenic Effects of Cyclophosphamide (NSC-26271) in the Rat , Cancer Chemother Rep 51:363-376 ( (Oct) ) 1967. 21. Gowans, J.L.: The Recirculation of Lymphocytes From Blood to Lymph in the Rat , J Physiol 146:54-69 ( (April) ) 1959. 22. Gowans, J.L., and McGregor, D.D.: The Immunologic Activities of Lymphocytes , Prog Allerg 9:1-78, 1965. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cyclophosphamide Therapy of Peripheral Uveitis

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Publisher
American Medical Association
Copyright
Copyright © 1969 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1969.00300170031006
Publisher site
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Abstract

Abstract The effectiveness of the cytotoxic drug, cyclophosphamide, has been evaluated in 16 patients with refractory uveitis. Clinically significant suppression of inflammation occurred in nine of nine patients with peripheral uveitis. Results were less predictable in other forms of uveitis. Toxic side effects of cyclophosphamide were less than those reported with mercaptopurine and other metabolic inhibitors or those associated with long-term high dosage systemic steroid therapy. Combined steroid and cyclophosphamide therapy was most effective in suppressing inflammation. Cyclophosphamide decreased the risk of adverse effects of hypertension and diabetes in patients on prolonged steroid therapy. Lymphopenia with or without leukopenia correlated best with control of ocular inflammation. Cyclophosphamide is a potentially useful drug in the care of patients with significant autoallergic disease. References 1. Wong, V.G., and Hersh, E.M.: Methotrexate in the Therapy of Cyclitis , Trans Amer Acad Ophthal Otolaryng 69:279-292 ( (March-April) ) 1965. 2. Newell, F.K., and Krill, A.E.: Treatment of Uveitis With Azathioprine (Imuran) , Trans Ophthal Soc UK 87:499-510 ( (April) ) 1967. 3. Newell, F.W.; Krill, A.E.; and Thompson, A.: The Treatment of Uveitis With 6-Mercaptopurine , Amer J Ophthal 61:1250-1255 ( (May) ) 1966. 4. Turk, J.L., and Stone, S.H.: " Implications of the Cellular Changes in Lymph During the Development and Inhibition of Delayed Hypersensitivity , in Amos, D.B. and Koprowski, H. (eds.): Cell Bound Antibodies , Philadelphia: Wistar Institute Press, 1963, pp 51-60. 5. Turk, J.L.: " The Effect of Immunosuppressive Drugs on Cellular Changes After Antigenic Stimulation ," In Mihich, E. (ed.): Immunity, Cancer and Chemotherapy , New York: Academic Press, Inc., 1967 pp 2-16. 6. Miller, J.J., and Cole, L.J.: Resistance of Long-Lived Lymphocytes and Plasma Cells in Rat Lymph Nodes to Treatment With Prednisone, Cyclophosphamide, 6-Mercaptopurine and Actinomycin D , J Exp Med 126:109-125 ( (July) ) 1967.Crossref 7. Fahey, J.L., and McKelvey, E.M.: Quantitative Determination of Serum Immunoglobulins in Antibody-Agar Plates , J Immun 94:84-90 ( (Jan) ) 1965. 8. Buckley, C.E.; Nagaya, H.; and Sieker, H.O.: Altered Immunologic Activity in Sarcoidosis , Ann Intern Med 64:508-520 ( (March) ) 1966.Crossref 9. Nelson, Jr., R.A.: " The Role of Complement in Immune Phenomena ," in Zweifach, B.W.; Grant, L.; and McCluskey, R.T. (eds.): The Inflammatory Process , New York: Academic Press, Inc., 1965, pp 819-869. 10. Beauregard, W.G.; Webb, C.H.; and Smith, E.: Perisistent Eosinophilia Following Accidental Ingestion of Chloroambucil , J Louisiana Med Soc 117:104-109 ( (April) ) 1965. 11. Hitchings, G.H., and Elion, G.B.: Chemical Suppression of the Immune Response , Pharmacol Rev 15:365-405 ( (June) ) 1963. 12. Levin, R.H.; Landy, M.; and Frei, E.: The Effect of 6-Mercaptopurine on Immune Response in Man , New Eng J Med 271:16-22 ( (July) ) 1964.Crossref 13. Rogentine, Jr., G.N., et al: Metabolism of Human Immunoglobulin D (IgD) , J Clin Invest 45: 1467-1478 ( (Sept) ) 1966.Crossref 14. Murray, E.S.; O'Connor, J.M.; and Gaon, J.A.: Serologic Studies of Primary Epidemic Typhus to Recrudescent Typhus (Brill-Zinsser Disease): II. Differences in Immunoelectrophoretic Patterns, Response to 2-Mercaptoethanol and Relationships to 19 S and 7 S Antibodies , J Immun 94:734-740 ( (May) ) 1965. 15. Whitehouse, A.C., et al: Macroglobulinemia and Vasculitis in Sjogren's Syndrome: Experimental Observations Relating to the Pathogenesis , Amer J Med 43:609-619 ( (Oct) ) 1967.Crossref 16. Sahair, K., and Schwartz, R.S.: The Immunoglobulin Sequence: I. Arrest by 6-Mercaptopurine and Restitution by Antibody, Antigen or Splenectomy , J Immun 95:345-354 ( (Aug) ) 1965. 17. Schwartz, R.S.: " Alteration of Immunity by Antimetabolites ," in Mihich, E. (ed.): Immunity, Cancer and Chemotherapy , New York: Academic Press, Inc., 1967, pp 203-209. 18. Paterson, P.Y.; Hanson, M.A.; and Gerner, E.W.: Cyclophosphamide Inhibition of Experimental Allergic Encephalomyelitis in Wistar Rats , Proc Soc Exp Biol Med 124:928-932 ( (March) ) 1967.Crossref 19. Brock, N.: Pharmacologic Characterization of Cyclophosphamide (NSC-26271) and Cyclophosphamide Metabolites , Cancer Chemother Rep 51:315-325 ( (Oct) ) 1967. 20. Chaube, S.; Kury, G.; and Murphy, M.L.: Teratogenic Effects of Cyclophosphamide (NSC-26271) in the Rat , Cancer Chemother Rep 51:363-376 ( (Oct) ) 1967. 21. Gowans, J.L.: The Recirculation of Lymphocytes From Blood to Lymph in the Rat , J Physiol 146:54-69 ( (April) ) 1959. 22. Gowans, J.L., and McGregor, D.D.: The Immunologic Activities of Lymphocytes , Prog Allerg 9:1-78, 1965.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1969

References