Szpirt WM, Rasmussen N, Petersen J
Plasma exchange and cyclosporin A in Wegener's
granulomatosis: a controlled study
23rd ESAO Congress, Warsaw
Int J Artif Organs
(Sep) 10:501 1996
Neither plasmapheresis nor cyclosporin are standard therapies to treat
Wegener's granulomatosis. In this study, 32 patients with
ANCA-positive WG were divided into 4 groups. Half received 12 courses
of plasma exchange (PE) in addition to prednisolone plus
cyclophosphamide. These two primary groups were split again, with
half receiving cyclosporin A (CyA) after 3 months to diminish
long-term side effects of cyclophosphamide (CY).
It is
claimed that all groups were comparable at the start of therapy.
None of the 16 patients in the PE group showed progression at 1 or 3
months, vs. 6 or 5 patients in the non-PE treated patients. The rate
of progression after 1 year was similar in patients who continued to
received cyclophosphamide and in patients who had been switched to
cyclosporin A. However, there were more late relapses in the CY vs.
the CyA group. In patients with active disease, 3 were switched to PE
with remission. Switching from CyA to CY also helped when relapse
occurred in the patiens who had been switched to CyA. ANCA titers did
not correlate with outcome or clinical course.
Comment: The conclusion of these authors is, that PE should be
used "in all ANCA positive WG patients indepent of the degree of renal
function". Also, the authors suggest that one can switch from CY to
CyA early on, and switch back if exacerbation of disease develops.
This is a provocative paper even though the number of patients studied
was rather small. (John T. Daugirdas, M.D., University of
Illinois at Chicago)
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23rd ESAO Congress, Warsaw
Other extracorporeal therapies :
Plasmapheresis
Proteinuria/Hematuria :
Vasculitis (Wegener's PAN, etc.)