Evidence map›Paper›PMID 18567882›Full record

Trial reportAnnals of the New York Academy of Sciences2008

Rebooting the immune system with high-dose cyclophosphamide for treatment of refractory myasthenia gravis.

Daniel B Drachman, Robert N Adams, Rong Hu, Richard J Jones, Robert A Brodsky

Abstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of the New York Academy of Sciences, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 3 pooled it
4.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 3 syntheses or guidelines pooled it, 92 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Consistent improvement with eculizumab across muscle groups in myasthenia gravis.Annals of clinical and translational neurology · 2020
    Trial
  5. Trial
  6. Trial
  7. Trial
  8. Review
  9. Current Treatment of Myasthenia Gravis.Journal of clinical medicine · 2022
    Review
  10. Article
  11. Review
  12. Management of Juvenile Myasthenia Gravis.Frontiers in neurology · 2020
    Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Clinical features and outcomes of patients with myasthenia gravis.Neurosciences (Riyadh, Saudi Arabia) · 2019
    Article
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Daniel B DrachmanDepartment of Neurology, Johns Hopkins School of Medicine, Meyer Building 5-119, 600 North Wolfe Street, Baltimore, MD 21287-7519, USA. dandrac@aol.com
Robert N Adams
Rong Hu
Richard J Jones
Robert A Brodsky
Johns Hopkins Hospital · USJohns Hopkins University · US

Funding

THERAPEUTIC USE OF STEM CELLSP01CA070970 · NCI · JOHNS HOPKINS UNIVERSITY · PI CIVIN, CURT I · 1998 to 2012
$23.7M
TRAINING PROGRAM IN HEMATOLOGYT32HL007525 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI ROBERT A BRODSKY · 1985 to 2026
$6.2M
GENE TRANSFER FOR SPECIFIC IMMUNOTHERAPY OF MYASTHENIAR01NS040778 · NINDS · JOHNS HOPKINS UNIVERSITY · PI DRACHMAN, DANIEL B · 2001 to 2004
$1.4M
NCI NIH HHS P01 CA070970NCI NIH HHS P01 CA 70970NHLBI NIH HHS T32 HL007525NINDS NIH HHS R01 NS040778
6 · The paper itself

Abstract

A small but important proportion of patients with myasthenia gravis (MG) are refractory to conventional immunotherapy. We have treated 12 such patients by "rebooting" the immune system with high-dose cyclophosphamide (Hi Cy, 200 mg/kg), which largely eliminates the mature immune system, while leaving hematopoietic precursors intact. The objective of this report is to describe the clinical and immunologic results of Hi Cy treatment of refractory MG. We have followed 12 patients clinically for 1-9 years, and have analyzed their humoral and cellular immunologic parameters. Hi Cy is safe and effective. All but one of the patients experienced dramatic clinical improvement for variable periods from 5 months to 7.5 years, lasting for more than 1 year in seven of the patients. Two patients are still in treatment-free remission at 5.5 and 7.5 years, and five have achieved responsiveness to immunosuppressive agents that were previously ineffective. Hi Cy typically reduced, but did not completely eliminate, antibodies to the autoantigen AChR or to tetanus or diphtheria toxin; re-immunization with tetanus or diphtheria toxoid increased the antibody levels. Despite prior thymectomy, T cell receptor excision circles, generally considered to reflect thymic emigrant T cells, were produced by all patients. Hi Cy treatment results in effective, but often not permanent, remission in most refractory myasthenic patients, suggesting that the immune system is in fact "rebooted," but not "reformatted." We therefore recommend that treatment of refractory MG with Hi Cy be followed with maintenance immunotherapy.

Indexed as

AdultAgedAutoantibodiesCyclophosphamideDiphtheriaDose-Response Relationship, DrugFemaleFollow-Up StudiesHumansImmune SystemMaleMiddle AgedMyasthenia GravisReceptor Protein-Tyrosine KinasesReceptors, CholinergicTetanusAutoantibodiesCyclophosphamideMUSK protein, humanReceptor Protein-Tyrosine KinasesReceptors, Cholinergic

Identifiers

PMID18567882
PMCPMC3390145
OpenAlexW2051200447

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.