Cyclosporin for the prevention of disease reactivation in relapsing ANCA-associated vasculitis
Cyclosporin for the prevention of disease reactivation in relapsing ANCA-associated vasculitis
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DOI：
10.1093/ndt/13.8.2074
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发表时间：
1998-08-01
影响因子：
6.1
通讯作者：
Brunkhorst, R
中科院分区：
文献类型：
--
作者：
Haubitz, M;Koch, KM;Brunkhorst, R
背景在ANCA相关性血管炎患者中，成功的初始治疗后频繁复发仍然是一个主要的治疗问题。因此，需要具有低副作用潜力的长期预防性治疗。由于最近的数据表明T细胞参与ANCA相关性血管炎的发病机制，在7名患者（3名韦格纳肉芽肿，4名显微镜下多血管炎，均伴有肾脏受累）中研究了低剂量环孢素治疗的预防价值，这些患者在环磷酰胺（CP）治疗期间或CP治疗结束后的前4个月内至少复发一次。在使用CP和泼尼松龙达到缓解6个月后，降低CP剂量（3个月75%，3个月50%），同时添加环孢菌素（剂量调整至全血水平60 - 90 ng/ml）。CP治疗结束后继续环孢菌素治疗1年。在平均24个月的随访期间，没有患者复发。两名患者发生疱疹测试仪感染。无严重细菌感染发生。这些初步结果表明，环孢菌素可以成功地用于维持缓解复发过程中的ANCA相关血管炎和肾脏受累的患者。
Background. In patients with ANCA-associated vasculitis the frequent development of relapses after successful initial treatment remains a major therapeutic problem. Thus a long-term prophylactic therapy with low side-effect potential is needed. As recent data suggest an involvement of T cells in the pathogenesis of ANCA-associated vasculitis, the prophylactic value of therapy with low-dose cyclosporin was investigated in seven patients (three with Wegener's granulomatosis, four with microscopic polyangiitis, all with renal involvement) who had developed at least one relapse during cyclophosphamide (CP) treatment or in the first 4 months after the end of CP therapy.Methods. After remission had been achieved for 6 months using CP and prednisolone, the CP dose was reduced (3 months 75%, 3 months 50%) and cyclosporin was added concomitantly (dose adjusted to whole blood levels 60-90 ng/ml). Cyclosporin therapy was continued for 1 year after the end of CP treatment.Results. During a mean follow-up of 24 months no patient developed a relapse. Two patients developed a herpes tester infection. No severe bacterial infection occurred.Conclusions. These preliminary results indicate that cyclosporin can be successfully used to sustain remission in patients with a relapsing course of ANCA-associated vasculitis and renal involvement.