Therapy for the maintenance of remission in sixty‐five patients with generalized Wegener's granulomatosis. Methotrexate versus trimethoprim/sulfamethoxazole

Abstract

Objective. To compare the efficacy of low-dose intravenous (IV) methotrexate (MTX; 0.3 mg/kg once weekly), both with and without concomitant prednisone, versus daily oral trimethoprim/sulfamethoxazole (T/S; 160 mg of trimethoprim + 800 mg of sulfamethoxazole twice a day), with and without prednisone, in maintaining remission in patients with generalized Wegener's granulomatosis (WG).Methods. In this study, 65 patients with generalized WG whose disease had entered remission with cyclophosphamide (CYC) and prednisone therapy were started on one of the following remission-maintenance regimens: MTX alone (group A; n = 22), T/S alone (group B; n = 24), MTX plus conconlitant prednisone (group C; n = ll), and T/S plus concomitant prednisone (group D; n = 8). Clinical, radiographic, and seroimmunologic data were evaluated to assess the efficacy of the 4 regimens and to seek possible predictive factors concerning outcome in each group.Results. Partial or complete remission was maintained in 86% of the patients in group A, but in only 58% of those in group B (P < 0.05). In group C, 91% of patients remained in remission, which is in sharp contrast to group D, in which all patients experienced a relapse after a median of 14.5 months (P < 0.005). Side effects occurred twice as often with MTX (n = 12) as

Randomized trial of cyclophosphamide versus methotrexate for induction of remission in early systemic antineutrophil cytoplasmic antibody–associated vasculitis

“…The observed relapse rates of 69.5% and 46.5% in the MTX and CYC groups at 18 months were higher than in previous reports on these agents (7,20,(23)(24)(25)(26)(27). While this may have reflected differences in extent and duration of disease, it may also be the result of early cessation of immunosuppression at 12 months.…”

Updates in ANCA-associated vasculitis

“…Cotrimoxazole (trimethoprim-sulfamethoxazole) cannot substitute for immunosuppressive treatment (99), but given at a high dose (320 mg/day trimethoprim, 1600 mg/day sulfamethoxazole) and combined with the usual treatments of GPA, it could further reduce the rate of localized ENT relapse by 40% at 1 year, regardless of the presence or absence of S. aureus on nasal swabs (100). Importantly, cotrimoxazole must also be prescribed but at a lower dose (160 mg trimethoprim and 800 mg sulfamethoxazole, 3 days/week) for prophylaxis against Pneumocystis jiroveci pneumonia in patients who are receiving induction therapy with cyclophosphamide or rituximab and for several months after their discontinuation (69).…”

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

“…When kidney involvement was stratified according to sex, males presented with kidney involvement more frequently than females (57.8% versus 40.1%; P Ͻ 0.001). The median DEI at diagnosis and over the whole disease course was higher in males (at diagnosis, 9 [range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]; P ϭ 0.001). The median time to diagnosis after the occurrence of first symptoms was 6 months (range 0-250 months) for young males and 11 months (range 0-195 months) for young females (P ϭ 0.47).…”