Journal Article10.1056/NEJMOA020286
A Randomized Trial of Maintenance Therapy for Vasculitis Associated with Antineutrophil Cytoplasmic Autoantibodies
David Jayne,Niels Rasmussen,Konrad Andrassy,Paul A. Bacon,Jan Willem Cohen Tervaert,J. Dadoniene,Agneta Ekstrand,Gill Gaskin,Gina Gregorini,Kirsten de Groot,Wolfgang L. Gross,E. Christiaan Hagen,Eduardo Mirapeix,Erna Pettersson,Carl Siegert,Alberto Sinico,Vladimir Tesar,Kerstin Westman,Charles D. Pusey +18 more
TL;DR: In patients with generalized vasculitis, the withdrawal of cyclophosphamide and the substitution of azathioprine after remission did not increase the rate of relapse, suggesting the duration of exposure to cycloph phosphamide may be safely reduced.
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Abstract: Background The primary systemic vasculitides usually associated with autoantibodies to neutrophil cytoplasmic antigens include Wegener's granulomatosis and microscopic polyangiitis. We investigated whether exposure to cyclophosphamide in patients with generalized vasculitis could be reduced by substitution of azathioprine at remission. Methods We studied patients with a new diagnosis of generalized vasculitis and a serum creatinine concentration of 5.7 mg per deciliter (500 μmol per liter) or less. All patients received at least three months of therapy with oral cyclophosphamide and prednisolone. After remission, patients were randomly assigned to continued cyclophosphamide therapy (1.5 mg per kilogram of body weight per day) or a substitute regimen of azathioprine (2 mg per kilogram per day). Both groups continued to receive prednisolone and were followed for 18 months from study entry. Relapse was the primary end point. Results Of 155 patients studied, 144 (93 percent) entered remission and were randoml...
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Citations
Pulmonary-renal syndromes.
TL;DR: Recent evidence suggests that patients with severe ANCA-associated vasculitis, defined by the presence of diffuse alveolar haemorrhage and/or severe renal involvement, might benefit from plasma exchange in combination with cyclophosphamide and corticosteroids.
22
Infliximab in patients with systemic vasculitis that is difficult to treat: poor outcome and significant adverse effects
TL;DR: An open-label uncontrolled prospective study of anti-TNFα (infliximab) is described, in the management of patients with systemic vasculitides who failed to maintain remission on conventional immunosuppressive treatment.
ANCA Associated Vasculitis Subtypes: Recent Insights and Future Perspectives
TL;DR: An update on emerging evidence related to auto-antibodies, complement and lymphocyte pathways and emerging treatment regimens is presented, including evidence for plasma exchange in severe disease and the inhibitor of the complement C5a receptor (C5aR) inhibitor, Avacopan.
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Evidence-based management of ANCA vasculitis.
TL;DR: There is a firmer evidence base to guide management decisions for individual patients with primary inflammatory vascular diseases and this evidence base has led to the publication of treatment guidelines which importantly encompass many of the broader aspects of disease management.
22
References
The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
John E. Ware,Cathy D. Sherbourne +1 more
TL;DR: A 36-item short-form survey designed for use in clinical practice and research, health policy evaluations, and general population surveys to survey health status in the Medical Outcomes Study is constructed.
37.9K
The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
TL;DR: In this article, cross-sectional data from the Medical Outcomes Study (MOS) were analyzed to test the validity of the MOS 36-Item Short-Form Health Survey (SF-36) scales as measures of physical and mental health constructs.
9.3K
Nomenclature of systemic vasculitides. Proposal of an international consensus conference
Jc Jennette,Ronald J. Falk,K Andrassy,Pa Bacon,J Churg,J Churg,Wl Gross,Wl Gross,E. C. Hagen,Gs Hoffman,Gg Hunder,Cgm Kallenberg,Rt Mccluskey,Ra Sinico,Ra Sinico,Aj Rees,La Vanes,R Waldherr,Allan Wiik +18 more
TL;DR: The following are some of the conclusions and proposals made at the Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis.
3.8K
Wegener granulomatosis : an analysis of 158 patients
Gary S. Hoffman,Gail S. Kerr,Randi Y. Leavitt,Claire W. Hallahan,Robert S. Lebovics,William D. Travis,Menachem Rottem,Anthony S. Fauci +7 more
TL;DR: The course of Wegener granulomatosis has been dramatically improved by daily treatment with cyclophosphamide and glucocorticoids, and has led to increasing concerns about toxicity resulting from prolonged cycloph phosphamide therapy and has encouraged investigation of other therapeutic regimens.
2.9K
Wegener's granulomatosis: Prospective clinical and therapeutic experience with 85 patients for 21 years
TL;DR: It is shown that long-term remissions can be induced and maintained in an extremely high number of patients by the combination of daily cyclophosphamide and alternate-day prednisone therapy.
2K
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