Abstract
Purpose
To determine the relapse rate and outcome in patients with Wegener’s granulomatosis
treated with daily cyclophosphamide and glucocorticoids to induce remission followed
by methotrexate for remission maintenance.
Methods
We performed an open-label prospective study in 42 patients with active Wegener’s
granulomatosis. All patients were treated with a standardized regimen. Outcomes were
assessed using predetermined definitions based on clinical characteristics and pathologic,
laboratory, and radiographic findings.
Results
All patients achieved disease remission. The median time to remission was 3 months,
and the median time to discontinuation of glucocorticoids was 8 months. During a median
of 32 months of follow-up, 1 patient died (of a myocardial infarction not related
to vasculitis). Two patients (5%) had to withdraw from the study because of medication
toxicity. Twenty-two patients (52%) relapsed, with glomerulonephritis occurring in
16 patients. Of these 16 patients, 4 had an increase of >0.2 mg/dL in serum creatinine
level. All 4 patients returned to their prior level of renal function with treatment.
None of the 22 relapses met the criteria for severe disease.
Conclusion
The use of cyclophosphamide and glucocorticoids for induction and methotrexate for
maintaining remission is an effective and well-tolerated therapeutic approach in patients
with active Wegener’s granulomatosis.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Wegener’s granulomatosis.Ann Intern Med. 1983; 98: 76-85
- Wegener granulomatosis.Ann Intern Med. 1992; 116: 488-494
- A staged approach to the treatment of Wegener’s granulomatosis.Arthritis Rheum. 1999; 42: 2666-2673
- The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis.Arthritis Rheum. 1990; 33: 1101-1107
- An analysis of forty-two Wegener’s granulomatosis patients treated with methotrexate and prednisone.Arthritis Rheum. 1995; 38: 608-613
- Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis.Arthritis Rheum. 1996; 39: 1791-1801
- Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis.N Engl J Med. 1997; 337: 382-387
- Limited prognostic value of changes in antineutrophil cytoplasmic antibody titer in patients with Wegener’s granulomatosis.Arthritis Rheum. 1993; 36: 365-371
- Non-parametric estimation from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481
- An interdisciplinary approach to the care of patients with Wegener’s granulomatosis.Arthritis Rheum. 2000; 43: 1021-1032
- A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener’s granulomatosis.Arthritis Rheum. 1997; 40: 2187-2198
- Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener granulomatosis.Ann Intern Med. 1996; 124: 477-484
- The epidemiology of We-gener’s granulomatosis. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources.Arthritis Rheum. 1996; 39: 87-92
- High rate of renal relapse in 71 patients with Wegener’s granulomatosis under maintenance of remission with low-dose methotrexate.Arthritis Care Res. 2002; 47: 326-332
- Update on the European Vasculitis Study Group trials.Curr Opin Rheumatol. 2001; 13: 48-55
Article info
Publication history
Accepted:
December 10,
2002
Received in revised form:
December 10,
2002
Received:
July 10,
2002
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
