The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning. A prospective clinical trial of pulse therapy with glucocorticoid and cyclophosphamide in moderate to severe paraquat-poisoned patients. Repeated pulse of methylprednisolone and cyclophosphamide with continuous dexamethasone therapy for patients with severe paraquat poisoning.
Paraquat is a bipyridil herbicide and in appropriate and careful usage, will not be health threatening. Most adult cases of intoxication are due to suicidal attempts rather than accidental exposure. Therapeutic response has been reported to be appropriate with high doses of cyclophosphamide and glucocorticoids and survival is reported to be approximately 75%. So, this study was designed to evaluate the effects of combined treatment with cyclophosphamide and glucocorticoids in patients with paraquat poisoning.
                During a two-year period 45 patients with paraquat poisoning were admitted to Sina Hospital, Hamadan, Iran, of whom 20 had moderate to severe intoxication. Eleven patients (group 1) received conventional treatment and nine patients (group 2) received conventional treatment plus intravenous infusions of cyclophosphamide 15 mg/kg daily for two days, methylprednisolone one gram daily for three days, and mesna 15 mg/kg for four days.
                The mean age+/-SD in group 1 was 25+/-10 years and in group 2 was 26+/-10 years. In group 1 three patients were females and eight patients were males. In group 2 one patient was female and eight patients were males. There were no differences between the groups in the time elapsed from ingestion to presentation at hospital or in the beginning of hemodialysis. The mortality rate in group 1 was 81.8% and in group 2 was 33.3% (P< 0.05). All fatalities caused by acute respiratory distress syndrome.
                Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe paraquat poisoning. nan Paraquat is widely used in the world, and all treatments for paraquat poisoning have been unsuccessful. Many patients have died of paraquat poisoning in developing countries. A novel anti-inflammation method was developed to treat severe paraquat-poisoned patients with >50% to <90% predictive mortality: initial pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 2 days), followed by dexamethasone 20 mg/day until Pao2 was >11.5 kPa (80 mm Hg) and repeated pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 1 day), which was repeated if Pao2 was <8.64 kPa (60 mm Hg).
                Randomized controlled trial.
                Academic medical center in Taiwan.
                Twenty-three paraquat-poisoned patients with >50% and <90% predictive mortality assessed by plasma paraquat levels were prospectively and randomly assigned to the control and study groups at a proportion of 1:2.
                The control group received conventional therapy and the study group received the novel repeated pulse treatment with long-term steroid therapy.
                We measured patient mortality during the study period. There was not a different distribution of basal variables between the two study groups. The mortality rate (85.7%, six of seven) of the control group was higher than that of the study group (31.3%, five of 16; p = .0272).
                The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquat poisoning.
Based on the findings of three small RCTs of moderate to severely poisoned patients, glucocorticoid with cyclophosphamide in addition to standard care may be a beneficial treatment for patients with paraquat-induced lung fibrosis. To enable further study of the effects of glucocorticoid with cyclophosphamide for patients with moderate to severe paraquat poisoning, hospitals may provide this treatment as part of an RCT with allocation concealment.