Download Disease-modifying Therapy in Vasculitides by Cees G.M. Kallenberg, Jan W. Cohen Tervaert PDF

By Cees G.M. Kallenberg, Jan W. Cohen Tervaert

Especially the previous 20 years have noticeable renewed curiosity within the vasculitides. during this quantity a world professional staff provides the present kingdom of information and concentrates on rules of immune modulating treatment. Drawing from their paintings in rheumatology, nephrology, inner drugs, connective tissue sickness and scientific immunology, they current new suggestions in classificiation, analysis and pathophysiology of the vasculitides. proof from experimental and medical trials is reviewed, in addition to the outlook for extra research.

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In patients without severe extrarenal disease there is a potential benefit for the combination of plasma exchange, cyclophosphamide, and corticosteroids [32]. In an analysis of all published data, Levy and Pusey found that 44 of 58 (76%) dialysisdependent patients who were treated with plasma exchange in combination with conventional treatment came off dialysis, whereas 87 of 151 (58%) patients came off dialysis when treated with corticosteroids and cyclophosphamide only [33]. At present, a prospective study is being performed in which pulses of methylprednisone are being compared with plasma exchange in patients with severe renal involvement ("the MEPEX study") [29].

De Groot et al. reported that remission could be maintained in 19 of 22 patients who received MTX as monotherapy (median follow-up: 16 months), whereas remission could be maintained in 10 of 11 patients 29 Jan W. Cohen Tervaert et al. who received MTX in combination with low-dose prednisone (median follow-up: 22 months) [55]. In another open label trial, Langford et al. tested 20-25 mg/week MTX as maintenance therapy in 31 patients; in 84% of those patients remission could be maintained (median follow-up 16 months) [49].

After achieving complete remission cyclophosphamide dose was reduced by 25 mg every 2-3 months. To reduce cyclophosphamide toxicity, we use cyclophosphamide during a much shorter period. We start to reduce the dose of cyclophosphamide already 3 months after diagnosis and stop cyclophosphamide treatment 15-18 months after diagnosis [53]. 28 Standard therapeutic regimen s for vasculitis 25,-----------------------------------------, 20 -t---_ • • cyclop hosphamide azathioprine 15 -t---II 10 5 Induction 0-3 months Remission 3- 18 months Figure 1 Frequency of severe and life-threatening adverse effeds in the CYCAZAREM trial.

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