What are the complications of steroids and cyclophosphamide in the treatment of polyarteritis nodosa (PAN)?

Updated: Nov 14, 2017
  • Author: Dana Jacobs-Kosmin, MD, FACP; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Potential toxicities of cyclophosphamide to be discussed with patients include an increased risk of bladder cancer, hematologic malignancies, hemorrhagic cystitis, bladder fibrosis, bone marrow suppression, and gonadal failure.

Guillevin et al suggested that patients with a 5-factors score (FFS) of zero may be treated successfully with corticosteroids alone, with cyclophosphamide administered only as second-line treatment in cases of persistent disease, relapse, or inability to taper steroids. They recommend that, cyclophosphamide should be part of the initial regimen in combination with steroids in patients with an FFS of 1 or more. [41]

Therapy with steroids and cyclophosphamide places patients at high risk for infections. Prophylaxis for Pneumocystis jiroveci pneumonia (PCP) is encouraged in these patients.


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