A Controlled Trial of Cyclophosphamide in Rheumatoid Arthritis: Cooperating Clinics Committee of the American Rheumatism Association

Abstract

Cyclophosphamide was given for 32 weeks to 48 patients with severe active rheumatoid arthritis. Twenty received a high dose (up to 150 mg daily), and 28 a low dose (up to 15 mg daily). In comparison to the low-dose group, the high-dose patients showed greater reduction in disease activity in five of the six measures evaluated, in the assessments of both physicians and patients, and in the summing of changes in individual patients. More of the high-dose patients had reductions of rheumatoid-factor titer and of serum immunoglobulin G. A unique reduction in hand-joint erosions was found on x-ray study in the high-dose group. The clinical response was not related to leukopenia or to specific white-cell depressions. Untoward effects were observed in 90 per cent of the high-dose and 40 per cent of the low-dose groups. Herpes zoster, cystitis and major hair loss were virtually confined to the former.