Alternative treatment for preventing relapse of certain type of vasculitis appears less effective

Nov 08, 2010

In a comparison of treatments for maintaining remission of a certain type of vasculitis (inflammation of blood vessels), the immunosuppressant mycophenolate mofetil, regarded as an alternative to the drug often used to prevent relapse, azathioprine, was less effective, according to a study that will appear in the December 1 print edition of JAMA. The study is being released early online to coincide with its presentation at the American College of Rheumatology annual scientific meeting.

"Relapses of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) occur in 50 percent of patients within 5 years of diagnosis, and treatment toxicity is common. Safe and effective therapies to maintain remission of AAV are a priority," the authors write. "In AAV, small observational studies and randomized controlled trials reported successful remission induction and remission maintenance with mycophenolate mofetil. Whether mycophenolate mofetil is more effective than azathioprine [an immunosuppressive] for preventing relapses in AAV is uncertain."

Thomas F. Hiemstra, M.D., M.R.C.P., of the University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, England, and colleagues examined whether mycophenolate mofetil reduces the risk of relapse compared with azathioprine in patients with AAV in remission, and compared the risk of serious adverse events between treatment groups. The randomized trial was conducted at 42 centers in 11 European countries between April 2002 and January 2009. Eligible patients had newly diagnosed AAV and were ages 18 to 75 years at diagnosis. Patients were randomly assigned to receive azathioprine or mycophenolate mofetil after induction of remission with the agents cyclophosphamide and prednisolone.

A total of 156 patients were assigned to azathioprine (n = 80) or mycophenolate mofetil (n = 76) and were followed up for a median (midpoint) of 39 months. The researchers found that relapses were more common in the mycophenolate mofetil group (42/76 patients; 18 with major and 24 with minor relapses) compared with the azathioprine group (30/80 patients; 10 with major and 20 with minor relapses).

Severe adverse events did not differ significantly between groups, with 22 severe adverse events in 13 patients (16 percent) in the azathioprine group and 8 severe adverse events in 8 patients (7.5 percent) in the mycophenolate mofetil group. There were 8 severe infections in 8 patients in the azathioprine group and 3 severe infections in 3 patients in the mycophenolate mofetil group.

The secondary outcomes of Vasculitis Damage Index, estimated glomerular filtration rate (a measure of kidney function), and proteinuria (the presence of excessive protein in the urine) did not differ significantly between groups.

"Although mycophenolate mofetil is frequently regarded as a potent alternative to , we found no evidence to support its use as the initial maintenance therapy for patients with AAV," the authors write.

Explore further: US orders farms to report pig virus infections

More information: JAMA. 2010;304[21] doi:10.1001/jama.2010.1658

add to favorites email to friend print save as pdf

Related Stories

Alternative therapy for lupus nephritis

Apr 15, 2009

Lupus is a rare but serious disease that mainly affects women of child-bearing age and occurs when the body's immune system goes awry, damaging a variety of organs. When kidneys are targeted, patients develop lupus nephritis, ...

2-drug combo twice as effective for Crohn's disease remission

Apr 14, 2010

A study led by Mayo Clinic suggests remission from Crohn's disease may be more likely if patients get biologic therapy combined with immune-suppressing drugs first instead of immune-suppressing drugs alone. The study, published ...

Recommended for you

US orders farms to report pig virus infections

Apr 18, 2014

The U.S. government is starting a new program to help monitor and possibly control the spread of a virus that has killed millions of pigs since showing up in the country last year.

Foreigner dies of MERS in Saudi

Apr 18, 2014

A foreigner has died after she contracted MERS in the Saudi capital, the health ministry said on announced Friday, bringing the nationwide death toll to 73.

Vietnam battles fatal measles outbreak

Apr 18, 2014

Vietnam is scrambling to contain a deadly outbreak of measles that has killed more than 100 people, mostly young children, and infected thousands more this year, the government said Friday.

New clues on tissue scarring in scleroderma

Apr 18, 2014

A discovery by Northwestern Medicine scientists could lead to potential new treatments for breaking the cycle of tissue scarring in people with scleroderma.

User comments : 0

More news stories

Treating depression in Parkinson's patients

A group of scientists from the University of Kentucky College of Medicine and the Sanders-Brown Center on Aging has found interesting new information in a study on depression and neuropsychological function in Parkinson's ...

Airbnb rental site raises $450 mn

Online lodging listings website Airbnb inked a $450 million funding deal with investors led by TPG, a source close to the matter said Friday.

Health care site flagged in Heartbleed review

People with accounts on the enrollment website for President Barack Obama's signature health care law are being told to change their passwords following an administration-wide review of the government's vulnerability to the ...