AB0796 Short term treatment response to intravenous pulse cyclophosphamide treatment in connective tissue related interstitial lung disease
Authors: P.T. Antony
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Interstitial lung disease (ILD) is a major cause for morbidity and mortality in patients suffering from connective tissue diseases. Early detection and prompt recognition of symptoms with appropriate treatment is necessary for effective control of the disease and for better prognosis and long-term survival. Various treatments have been approved based on observational studies. We have very few studies as regards ILD treatment from the Indian subcontinent. In a resource constrained country like India, we mainly rely on cheap drugs like cyclophosphamide. We have done a study to assess the short-term treatment response of connective tissue related interstitial lung disease to cyclophosphamide in a tertiary centre in India. <h3>Objectives</h3> <b>1.</b>To assess short treatment outcome for Connective tissue disease related interstitial lung disease treated with intravenous pulses of cyclophosphamide (CYP) based on improvement in- Lung function 11) Forced vital capacity (FVC)% predicted, forced expiratory volume in first second (FEV1)% predicted 2) Dyspnoea Borg scale 3) Cough visual analogue score <b>2</b>. To determine the factors affecting treatment outcome like age, sex, duration of the connective tissue disease, type of connective tissue disease, HRCT type and presence of PAH. <h3>Methods</h3> A cohort study was conducted in the Department of General Medicine, Rheumatology and Pulmonology in Amala Institute of Medical Sciences, Thrissur, Kerala from November 2015 to June 2017, that evaluated 74 patients who were having connective tissue disease related ILD. Detailed history and a thorough clinical examination was done. Treatment with 6 intravenous pulses of cyclophosphamide was done and response was assessed after 6 months. Response to treatment and associations were analysed using SPSS software (version 15). Method used for statistical analysis was Chi –Square test and paired t test. <h3>Results</h3> There was no association between treatment response and age, sex or type of connective tissue disease. Following treatment there was a definite improvement in the clinical aspects of the patient which was assessed by dyspnoea Borg score and cough visual analogue score. Following treatment there was a definite improvement in PFT (FVC, FEV1) as well as 6 min walk test which was also statistically significant. CT pattern of Non specific interstitial pneumonitis also had a better outcome. <h3>Conclusions</h3> Our study proves that there is definite clinical and FVC improvement in CTD-ILD patients after giving treatment with cyclophosphamide. Determinants that can predict treatment outcome are duration of disease, HRCT type, (NSIP), presence of Pulmonary artery hypertension(PAH). Poor treatment response should be anticipated in those with longer duration of disease and UIP type in HRCT, presence of PAH. <h3>References</h3> [1] Simeon-Aznar C, Fonollosa-Plá V, Tolosa-Vilella C, Selva-O' Callaghan A, Solans-Laqué R, Palliza E, et al. Intravenous cyclophosphamide pulse therapy in the treatment of systemic sclerosis-related interstitial lung disease: a long term study. TORMJ. 2008;2(1):39–45 [] 2.Tashkin D, Elashoff R, Clements P, Goldin J, Roth M, Furst D, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med. 2006;354(25):2655–66. <h3>Disclosure of Interest</h3> None declared