Rheumatology Medical News about vasculitis;pulse vs daily oral cyclophosphamide

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Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis
Annals of Internal Medicine, 05/20/09

Groot KD et al. – Study demonstrates that pulse cyclophosphamide regimen induced remission of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis as well as the daily oral regimen at a reduced cumulative cyclophosphamide dose and caused fewer cases of leukopenia.

Methods

Aim was to compare pulse cyclophosphamide with daily oral cyclophosphamide for induction of remission
42 centers in 12 European countries
149 pts with ANCA-associated vasculitis with renal involvement but not immediately life-threatening disease, randomized to:
- Pulse cyclophosphamide, 15 mg/kg every 2 to 3 wks (76 pts), or
- Oral cyclophosphamide, 2 mg/kg per day (73 pts), plus prednisolone
Primary outcomes: time to remission
Secondary outcomes: change in renal function, adverse events, and cumulative dose of cyclophosphamide

Results

Groups did not differ in time to remission or proportion of pts who achieved remission at 9 mo
13 pts in the pulse group and 6 in the daily oral group achieved remission by 9 mo and subsequently had relapse
Absolute cumulative cyclophosphamide dose in the daily oral group was greater than that in the pulse group
The pulse group had a lower rate of leukopenia
The study was not powered to detect a difference in relapse rates between the 2 groups; duration of f/u was limited

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