Other names: Revimmune
Cyclophosphamide is a potent immunosuppressive drug that is frequently used in combination chemotherapy regimens to treat leukaemia and other forms of cancer. Cyclophosphamide binds to DNA and prevents cells dividing. Where it is used in MS, cyclophosphamide acts to reduce the numbers of T and B cells that can trigger an immune attack.
Historically, cyclophosphamide has been used as a treatment for people with MS who have failed to respond to other therapies and are experiencing frequent relapses with rapid progression. Research has shown only limited benefit from the treatment, and the side effects mean that it is rarely used. It is a possible candidate for use in combination therapies for MS, but there has been no research on this yet.
Revimmune is the brand name of an ultra-high intensity, short course intravenous infusion of cyclophosphamide that has been developed for a variety of autoimmune diseases. It may be a treatment option for people with severe refractory MS - MS that is not responding to other treatments.
How cyclophosphamide is given
Cyclophosphamide can be taken orally as tablets, as an injection into a vein (intravenously), or by drip (intravenous infusion).
Side effects and contraindications
In the short term, side effects can include hair loss, nausea, infertility, bladder irritation, gum soreness and risk of infection.
You should not breastfeed while taking cyclophosphamide, and you should use barrier contraception to prevent pregnancy. There is a risk of harm to the unborn baby from cyclophosphomide.
In the long term, side effects can include an increased chance of acquiring leukaemia, the interruption of menstrual cycling and the possible triggering of an early menopause.
A French study compared treatment with cyclophosphamide with IV methylpredisolone in people with secondary progressive MS. The study was ended early due to difficulty recruiting participants. Those people who stuck with cyclophosphamide over two years were 2.7 times less likely to show disability progression than the group taking the IV steroid. However, half of those taking cyclophosphamide and a third of those taking methylprednisolone dropped out, mostly due to tolerability issues. If data from all participants was included, the trial showed no difference between treatments.
- Cochrane Database of Systematic Reviews 2007;(1):CD002819. Summary Cyclophosphamide for multiple sclerosis.
- CNS Neuroscience and Therapeutics 2009;15(2):118-127. Summary High-dose cyclophosphamide in the treatment of multiple sclerosis.
- Archives of Neurology 2006;63(10):1388-1393. Summary High-dose cyclophosphamide for moderate to severe refractory multiple sclerosis.
- Archives of Neurology 2008;65(8):1044-1051. Summary Reduction of disease activity and disability with high-dose cyclophosphamide in patients with aggressive multiple sclerosis.
- PLoS One 2017;12(1):e0168834. Read the full article Double-blind controlled randomized trial of cyclophosphamide versus methylprednisolone in secondary progressive multiple sclerosis.