Cyclosporine for the prevention of relapses in ANCA- associated vasculitits
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:86A 1997
Therapy with prednisone (P) and cyclophosphamide (CP) results in remission of ANCA-associated vasculitis with renal involvement in about 90% of patients. However, about one-third subsequently relapse. Seven patients who developed at least one relapse during CP treatment or within 4 months of treatment cessation were treated with cyclosporine (CS) using the following protocol. After remission was achieved for 6 months using P and CP, the CP dose was reduced (3 months 75%, 3 months 50%) with concomitant addition of CS (to maintain whole blood levels 60 to 90 ng/ml); CS was continued for 1 year after the end of CP treatment. No patient developed a subsequent relapse during the next 18 months. Side effects were minimal.
Comment: Although oral cyclophosphamide is generally effective in sustaining remission in ANCA-associated vasculitis, there is much concern about long-term toxicity of this agent. Azathioprine is less toxic but also probably less effective. There have been some reports claiming benefit for trimethoprim- sulfamethoxazole. Low-dose cyclosporine may be a safe and effective agent for preventing relapses in ANCA-associated vasculitis. (David J. Leehey, M.D., Loyola University at Chicago)
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ASN 30th Annual Meeting, San Antonio
Proteinuria/Hematuria : Vasculitis (Wegener's PAN, etc.)