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Ocular Inflammatory Diseases

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Writing about ocular inflammatory diseases is way out of my depth. When I read the study below I had to write about cyclophosphamide aka cytoxan. Or I should say, the short, long-term and late stage side effects that can result as cytoxan therapy.

I am a long-term cancer survivor. I live with a host of long-term side effects some of which resulted from cytoxan therapy.

What are the known short, long-term and late stage side effect caused by cytoxan cyclophosphamide?

Short-term side effects can include:

  1. Nausea and vomiting
  2. Hair loss (alopecia)
  3. Fatigue
  4. Loss of appetite
  5. Increased susceptibility to infections due to decreased white blood cell count
  6. Risk of bleeding due to decreased platelet count
  7. Mouth sores
  8. Diarrhea or constipation
  9. Temporary infertility

Long-term side effects may include:

  1. Increased risk of infections, even after treatment ends
  2. Increased risk of developing other cancers, such as bladder cancer or leukemia
  3. Infertility, especially in men
  4. Damage to the heart (cardiotoxicity), leading to conditions like heart failure
  5. Damage to the lungs (pulmonary toxicity), leading to conditions like pulmonary fibrosis
  6. Kidney damage (nephrotoxicity)
  7. Risk of developing secondary autoimmune diseases

Late-stage side effects, which may manifest years after treatment, can include:

  1. Long-term infertility or premature menopause in women
  2. Increased risk of developing secondary cancers, such as bladder cancer or leukemia
  3. Cognitive impairments, including memory loss or difficulty concentrating
  4. Neurological problems, such as peripheral neuropathy (numbness or tingling in the hands and feet)
  5. Chronic pain
  6. Emotional and psychological effects, such as anxiety or depression

I don’t know about the ocular inflammatory diseases world but the world of cancer is carefully controlled by the FDA. As a result, the evidence-based, non-conventional therapies shown to reduce or eliminate the side effects that result from cytoxan are never discussed by oncology.

If you are considering cytoxan/cyclophosphomide therapy and would like to learn about nutritional supplementation and other therapies that can reduce your risk of side effects email me at David.PeopleBeatingCancer@gmail.com 

Hang in there,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies

“Background-Ocular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, and calcineurin inhibitors) as well as biologic agents like adalimumab, infliximab, rituximab, and tocilizumab.

Cyclophosphamide (CP) is an alkylating agent and mainly inhibits the functioning of both T and B cells. Though known to have potential adverse events, including bone marrow suppression, hemorrhagic cystitis, and sterility, CP has been shown to be efficacious, especially in recalcitrant cases and when used intravenous (IV) for a limited period…

Main findings- We conducted a retrospective case-series to assess the safety and efficacy of CP therapy for patients with severe ocular inflammatory diseases who failed other IMTs. Medical records of 1295 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were reviewed.

Seven patients (10 eyes) who received CP therapy for ocular inflammatory diseases with at least one year of follow-up were included. The mean age of the patients (4 males, 3 females) was 61.6 ± 14.9 (43.0–89.0) years.

Clinical diagnoses included

  • necrotizing scleritis (5 eyes),
  • peripheral ulcerative keratitis (2 eyes),
  • orbital pseudotumor (1 eye),
  • HLA-B27 associated panuveitis and
  • retinal vasculitis (2 eyes).

Ocular disease was idiopathic in 3 patients, and was associated with rheumatoid arthritis, IgG-4 sclerosing disease, dermatomyositis, and ankylosing spondylitis in 1 patient each. All the patients had history of previous IMT use including methotrexate (5), mycophenolate mofetil (3), azathioprine (1), tacrolimus (1), adalimumab (2), infliximab (4), and rituximab (1). The mean follow-up time was 34.4 ± 11.0 (13–45) months, and mean duration of CP therapy was 11.9 ± 8.8 (5–28) months. Remission was achieved in 5 patients (71.4%). Four patients (57.1%) experienced transient leukopenia (white blood cell count < 4000/mL).

Short conclusion

CP therapy can be considered a potentially effective and relatively safe therapeutic option for patients with severe ocular inflammatory diseases who failed other IMTs including biologics (TNFa and CD20 inhibitors)…

In conclusion, IV CP therapy may be considered a potentially effective treatment option with a relatively acceptable safety profile for patients with severe ocular inflammatory diseases who failed with other IMTs including biologic agents (TNFa and CD20 inhibitors). Close monitoring with regular blood work is essential for the management of these patients, as leukopenia was the most common adverse event.

Judicious use of IV CP appears favorable for severe, resistant ocular inflammation particularly when the potentially vision-saving benefits outweigh the substantial potential side effects of therapy.



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