Elevated relapse rate under oral methotrexate versus leflunomide for maintenance of remission in Wegener's granulomatosis

Metzler, Claudia; Miehle, Nikolaus; Manger, Karin; Iking‐Konert, Christof; Groot, Kirsten de; Hellmich, Bernhard; Gross, Wolfgang L.; Reinhold‐Keller, E.

doi:10.1093/rheumatology/kem029

Cited by 199 publications

(114 citation statements)

References 14 publications

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“…MTX was the main medication used for remission maintenance for approximately half of all patients in cohort 2, when a maintenance therapy was applied at all. Then AZA and LEF were increasingly administered due to evidence from new studies (9,13,29). Furthermore, the decline in relapse rates may also be related to the retaining of low-dose prednisone (3-5 mg/day) since the end of the 1990s.…”

Section: Discussionmentioning

confidence: 99%

Improved outcome in 445 patients with Wegener's granulomatosis in a German vasculitis center over four decades

Holle

Gross

Latza

et al. 2010

Arthritis & Rheumatism

251

143

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Objective. To determine the long-term outcome in patients with Wegener's granulomatosis (WG) over 4 decades in an academic hospital unit specializing in rheumatology.Methods. We included 290 patients, divided them into 2 cohorts, and compared them with the historical cohort of 155 patients. Comparisons were retrospective regarding disease manifestations, therapy, mortality, and incidence of malignancies. The historical cohort (cohort 1) included 155 patients diagnosed between 1966 and 1993, cohort 2 included 123 patients diagnosed between 1994 and 1998, and cohort 3 included 167 patients diagnosed between 1999 and 2002.Results. Over time, the interval between first symptoms and diagnosis was reduced by half (from 8 months to 4 months). Organ manifestations were similar in the 3 cohorts, and more than 80% of patients still required cyclophosphamide (CYC); however, the median cumulative dose was reduced significantly (from 67 gm in cohort 1 to 36 gm in cohort 2 and to 24 gm in cohort 3). The standardized mortality ratios ( Conclusion. Mortality of WG patients declined over the last 4 decades, probably due to improved diagnostic and therapeutic procedures and increased awareness of WG, which led to earlier diagnosis and therapy, reduction in relapse rates, and lower cumulative CYC dose with fewer deaths related to therapy.

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Section: Discussionmentioning

confidence: 99%

Improved outcome in 445 patients with Wegener's granulomatosis in a German vasculitis center over four decades

Holle

Gross

Latza

et al. 2010

Arthritis & Rheumatism

251

143

View full text Add to dashboard Cite

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“…A lefl unomid az AZA és MTX alternatívája lehet; egy 54, GPA-s beteget bevont vizsgálat 30 mg/nap lefl unomid hatékonyságát vetette össze 20 mg/hét dózisban adott MTX-szel, szignifi kánsan magasabb relapsusrátát találtak ez utóbbi csoportban, ugyanakkor a lefl unomidot szedőknél sokkal több volt a nemkívánatos esemény [33]. Egy tavaly megjelent review ismertette, hogy a nem biológiai fenntartó terápiák közül az MTX, az AZA és a lefl unomid hasonló hatékonyságú [34].…”

Section: Fenntartó Kezelésunclassified

Antineutrofil citoplazmatikus antitest asszociált vasculitisek korszerű kezelése

et al. 2015

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Összefoglaló tanulmányukban a szerzők a vasculitisek nómenklatúrájának és az antineutrofi l citoplazmatikus antitest asszociált vasculitisek felosztásának ismertetését követően bemutatják a betegségaktivitás mérésének lehetőségeit (5 tényezős pontrendszer, Birmingham Vasculitis Aktivitás Index), valamint ezek szerepét a terápiás igény meghatá-rozásában. Ismertetik az antineutrofi l citoplazmatikus antitest asszociált vasculitisek terápiás algoritmusát, külön rész-letezve az indukciós és a fenntartó kezelés során használható, több klinikai vizsgálat alapján is sokszor hasonló terá-piás értékű gyógyszerek dozírozását, leggyakoribb mellékhatásait, illetve ezek kivédésének lehetőségeit. Kiegészítő terápiaként többek között felhívják a fi gyelmet a plazmaferézis jelentőségére, illetve a gyógyszeres terápiák sikertelensége esetén szükségessé váló vesetranszplantáció feltételeire, várható kimenetelére. A közleményben ismertetnek szá-mos, jelenleg is folyó klinikai vizsgálatot, amelyek eredményei várhatóan a következő években tovább fogják szélesí-teni az antineutrofi l citoplazmatikus antitest asszociált vasculitisek terápiás lehetőségeit. Orv. Hetil., 2015, 156(41), 1653-1660. Kulcsszavak: antineutrofi l citoplazmatikus antitest asszociált vasculitis, ciklofoszfamid, tituximab, plazmaferézis Recent advances in the treatment of antineutrophil cytoplasm antibody associated vasculitidesThe authors review the nomenclature of vasculitides and the classifi cation of antineutrophil cytoplasm antibody associated vasculitides and present the method of measuring disease activity (Five-factor Score, Birmingham Vasculitis Activity Score) and its role in defi ning therapeutical needs. They discuss the treatment algorithm of antineutrophil cytoplasm antibody associated vasculitides, present the sometimes equipotential medications used during the induction therapy followed by a maintenance regimen, and outline their usage and possible side-effects that may require medical attention. They point out the importance of plasmapheresis as an adjunctive treatment in some cases, as well as indications and possible outcome of kidney transplantation in therapy-resistant cases. Finally, they review several ongoing clinical studies, as their outcome will probably infl uence therapeutical opportunities of antineutrophil cytoplasm antibody associated vasculitides in the next few years.Keywords: antineutrophil cytoplasm antibody associated vasculitis, cyclophoshamide, rituximab, plasmapheresis Szabó, M. Zs., Pálfi , P., Bazsó, A., Poór, Gy., Kiss, E. [Recent advances in the treatment of antineutrophil cytoplasm antibody associated vasculitides]. Orv. Hetil., 2015, 156(41), 1653-1660. (Beérkezett: 2015 elfogadva: 2015. augusztus

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“…A variety of maintenance therapies have also been evaluated in several trials, including the CYClophosphamide or AZathioprine As a REMission therapy for vasculitis (CYCAZAREM) trial 19 (cyclophosphamide versus azathioprine), Wegener's Granulomatosis-Entretien (WEGENT) trial 23 (azathioprine versus methotrexate), Leflunomide versus Methotrexate in the Therapy of ANCA Vasculitis (LEM) study, 25 and Azathioprine versus Mycophenolate Mofetil in the therapy of ANCA Vasculitis (IM-PROVE) study. 26 All of these approaches work, although azathioprine seems to be one of the best agents.…”

Section: Special Article Wwwjasnorgmentioning

confidence: 99%

“…16 Clinical comparative efficacy and observational studies revealed effective treatment for induction and maintenance therapy, discussed later in this review. [17][18][19][20][21][22][23][24][25][26][27] The quantity and quality of these clinical studies are a consequence of the clarification of nomenclature provided by the Chapel Hill Consensus Conference 28 and the successes of collaborative efforts within the European Vasculitis Study Group (EUVAS), 29 the European League Against Rheumatism (EULAR), 30 and the Vasculitis Clinical Research Consortium (VCRC). 31,32 Despite rapid and remarkable progress, further elucidation of this autoimmune disorder is needed to identify better treatment regimens that result in more effective, durable responses, if not cures, for these diseases.…”

mentioning

confidence: 99%

ANCA Disease

Falk¹,

Jennette

2010

Journal of the American Society of Nephrology

111

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Elevated relapse rate under oral methotrexate versus leflunomide for maintenance of remission in Wegener's granulomatosis

Cited by 199 publications

References 14 publications

Improved outcome in 445 patients with Wegener's granulomatosis in a German vasculitis center over four decades

Improved outcome in 445 patients with Wegener's granulomatosis in a German vasculitis center over four decades

Antineutrofil citoplazmatikus antitest asszociált vasculitisek korszerű kezelése

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