Cyclophosphamide in the Treatment of Refractory Proliferative Arachnoiditis in CNS Tuberculosis
Status:
Not yet recruiting
Trial end date:
2024-12-31
Target enrollment:
Participant gender:
Summary
Tubercular meningitis occurs in around 10% of those with extrapulmonary tuberculosis and is a
major cause of mortality and morbidity. Inspite of effective Anti-tubercular drugs, still
around 30% of patients develop complications due to arachnoiditis such as spinal tubercular
radiculomyelitis, optico-chiasmatic arachnoiditis, development of new tuberculomas after
starting therapy etc. which are probably immune mediated inflammatory responses due to
paradoxical reaction to ATT.
The management of arachnoiditis is far from satisfactory. High dose methylprednisolone,
intrathecal hyaluronic acid, thalidomide have been tried in small case series and case
reports. However, the results have not been satisfactory.
There are two published reports of cyclophosphamide usage in TBM related vasculitis and
stroke The investigators tried cyclophosphamide in four patients after consent, and found
remarkable improvement in all of them. (Under peer review) In order to test this hypothesis,
a randomized controlled trial is needed.
Phase:
Phase 2/Phase 3
Details
Lead Sponsor:
All India Institute of Medical Sciences, New Delhi