The Use of Alkylating Agents in the Treatment of Wegener's Granulomatosis

Hollander, Daniel; Manning, Robert T.

doi:10.7326/0003-4819-67-2-393

Cited by 208 publications

(56 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Whereas current guidelines from the Japanese Society of Nephrology suggest that glucocorticoids alone may be sufficient to induce remission in the majority of patients with MPA and renal disease, 10 this is clearly not the case for patients with MPA described in other cohorts 4 and patients with GPA and renal disease. In GPA with renal disease, glucocorticoids could only delay the inevitable fatal outcome, 11 which was changed by the introduction of CYC. Because glucocorticoids were equal in both treatment arms and discontinued by 6 months in most patients, differences in overall and renal outcomes between the treatment arms would have to be attributed to the effects of RTX versus CYC/AZA.…”

Section: Discussionmentioning

confidence: 99%

Rituximab Versus Cyclophosphamide for ANCA-Associated Vasculitis with Renal Involvement

Geetha

Specks

Stone

et al. 2015

Journal of the American Society of Nephrology

148

112

View full text Add to dashboard Cite

Rituximab (RTX) is non-inferior to cyclophosphamide (CYC) followed by azathioprine (AZA) for remissioninduction in severe ANCA-associated vasculitis (AAV), but renal outcomes are unknown. This is a post hoc analysis of patients enrolled in the Rituximab for ANCA-Associated Vasculitis (RAVE) Trial who had renal involvement (biopsy proven pauci-immune GN, red blood cell casts in the urine, and/or a rise in serum creatinine concentration attributed to vasculitis). Remission-induction regimens were RTX at 375 mg/m 2 3 4 or CYC at 2 mg/kg/d. CYC was replaced by AZA (2 mg/kg/d) after 3-6 months. Both groups received glucocorticoids. Complete remission (CR) was defined as Birmingham Vasculitis Activity Score/Wegener's Granulomatosis (BVAS/WG)=0 off prednisone. Fifty-two percent (102 of 197) of the patients had renal involvement at entry. Of these patients, 51 were randomized to RTX, and 51 to CYC/AZA. Mean eGFR was lower in the RTX group (41 versus 50 ml/min per 1.73 m 2 ; P=0.05); 61% and 75% of patients treated with RTX and 63% and 76% of patients treated with CYC/AZA achieved CR by 6 and 18 months, respectively. No differences in remission rates or increases in eGFR at 18 months were evident when analysis was stratified by ANCA type, AAV diagnosis (granulomatosis with polyangiitis versus microscopic polyangiitis), or new diagnosis (versus relapsing disease) at entry. There were no differences between treatment groups in relapses at 6, 12, or 18 months. No differences in adverse events were observed. In conclusion, patients with AAV and renal involvement respond similarly to remission induction with RTX plus glucocorticoids or CYC plus glucocorticoids.

show abstract

Section: Discussionmentioning

confidence: 99%

Rituximab Versus Cyclophosphamide for ANCA-Associated Vasculitis with Renal Involvement

Geetha

Specks

Stone

et al. 2015

Journal of the American Society of Nephrology

148

112

View full text Add to dashboard Cite

show abstract

“…The introduction in the 1960s of corticosteroids only extended average survival by 8 months. 6 This changed radically when Fauci and Wolff 7 pioneered the use of cyclophosphamide in the early 1970s. The administration of daily oral cyclophosphamide (1-2 mg/kg) and prednisone (1 mg/kg) resulted in a dramatic clinical benefit.…”

Section: Evidence Synthesis Rationale For the Current Approachmentioning

confidence: 99%

Treatment of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Bosch¹,

Guilabert²,

Espinosa³

et al. 2007

JAMA

175

106

View full text Add to dashboard Cite

“…None of these modalities were successful. Corticosteroid treatment was also tried and it has been shown that corticosteroid alone doubled the life expectancy to about 12 months with a 1-year survival of 34% (77). Adding cyclophosphamide to corticosteroid therapy altered the prognosis of the disease and resulted in remission and extension of the survival rate (33).…”

Section: Systemic Treatmentmentioning

confidence: 99%