‘RETROSPECTIVE STUDY OF EFFICACY OF I. V

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Presentation transcript:

‘RETROSPECTIVE STUDY OF EFFICACY OF I. V ‘RETROSPECTIVE STUDY OF EFFICACY OF I.V. DEXAMETHASONE- CYCLOPHOSPHAMIDE PULSE THERAPY IN ESTABLISHED SYSTEMIC SCLEROSIS’ BY DR.ANUP KUMAR TIWARY

THERAPY INTRODUCTION VASODILATORS AUTO-ANTIBODIES AUTO-IMMUNE, SYSTEMIC SCLEROSIS AUTO-IMMUNE, MULTISYSTEM DISORDER VASCULAR ABNORMALITIES CONNECTIVE TISSUE SCLEROSIS AUTO-ANTIBODIES THERAPY VASODILATORS IMMUNO SUPPRESSIVE ANTIFIBROTICS & ANALGESICS,PPI etc. SYMPTOMATIC – ANTIBIOTIC,

ObjeCTIVE TO INVESTIGATE THE EFFICACY OF I.V. DCP THERAPY IN IMPROVEMENT OF SKIN INDURATION & PULMONARY FUNCTION IN ESTABLISHED SYSTEMIC SCLEROSIS.

MATERIALS & METHODS 6 FEMALE CASES ACCORDING TO ARA SCLERODERMA CRITERIA WITH SKIN SCLEROSIS & ILD CONFIRMED CLINICALLY SYSTEMIC SCLEROSIS (LcSS & DcSS) 3 minor criteria (a) sclerodactyly (b) digital pitted scarring MAJOR- Scleroderma proximal to the digits CRITERIA : (c) b/l basal pulmonary ﬁbrosis. 1 MAJOR + 2 MINOR IS REQUIRED. & DURATION OF DISEASE – 2-7Yrs. Aug.2013 & Sept.2014 ADMITTED BETWEEN AGE GROUP : 24 – 42 Yrs. TREATED WITH I.V. (PENTOXIFYLLINE) MONTHLY FOR 12 DCP THERAPY VASODILATOR MONTHS TO ALL PATIENTS WERE GIVEN ORALLY

DEMOGRAPHIC AND CLINICAL DATA PATIENT GENDER AGE IN YRS. DURATION TYPE DURATION OF SKIN INDURATION IN YRS. DURATION OF RESPI. SYMPTOMS 1. F 38 5 LIMITED 3 1 2. 40 DIFFUSE 2 3. 24 6 4. 42 5. 39 7 6. 37

EXCLUSION CRITERIA IMPAIRED LIVER & KIDNEY FUNCTION ACTIVE INFECTION TOTAL LYMPHOCYTE COUNT <1000/ml TOTAL WBC <4000/ml PREGNANT OR LACTATING WOMEN & WOMEN PLANNING TO CONCIEVE HISTORY OF OTHER CYTOTOXIC DRUGS IN LAST 1 YR. ACTIVE INFECTION

MEASURES OF ASSESSMENT OF IMPROVEMENT MRSS (Modified RODNAN Skin Score) for skin induration by manual palpation. PFT (FVC & FEV1)-based on ATS Guidelines > 10% increment in %FVC & %FEV1 of normal values. (IMPROVEMENT) < 10% increment in %FVC & %FEV1 of normal values. (STABLE)

MODIFIED RODNAN SKIN SCORE TOTAL 17 SITES 0-NORMAL 1-MILD 2-MODERATE 3-SEVERE MAX.SCORE = 51

RESULTS

STATISTICAL ANALYSIS P VALUE CALCULATED BY SPSS SOFTWARE. 0.0043 for %FVC & 0.0021 for FEV1% PAIRED STUDENT t-TEST- 0.0002 WILCOXAN RANK SUM TEST- For MRSS PAIRED STUDENT t-TEST For %FVC & FEV1% WILCOXAN RANK SUM TEST DATA ARE COMPARED BETWEEN BASELINE & 12 MONTHS P VALUE <0.05 WAS TAKEN AS SIGNIFICANT

DISCUSSION Significant successive improvement at 3,6 & 12 months in pulmonary function in 5 cases. In one case pulmonary function remained stable (<10% improvement in PFT). Decrease in skin score in all cases.

Supported by convincing data from– Scleroderma Lung Study Research Group, University of California,Los Angeles,USA. Long term study by Barcelona University, Spain. Systemic sclerosis study group of Italian Society of Rheumatology

CONCLUSION I.V. DCP Regime given for 12 months significantly decrease skin induration & improve the pulmonary function in established interstitial lung disease.

THANK YOU THANK YOU