Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

Pagnoux, Christian; Mahr, Alfred; Hamidou, M.; Boffa, Jean‐Jacques; Ruivard, M.; Ducroix, J.P.; Kyndt, X.; Lifermann, François; Papo, Thomas; Lambert, Marc; Noach, J. Le; Khellaf, Mehdi; Merrien, Dominique; Puéchal, Xavier; Vinzio, S.; Cohen, Pascal; Mouthon, Luc; Cordier, Jean-François; Guillevin, Loı̈c

doi:10.1056/nejmoa0802311

Cited by 601 publications

(312 citation statements)

References 26 publications

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“…Oral cyclophosphamide or azathioprine was indicated as an immunosuppressive agent during remission maintenance in the JMAAV protocol, but the agents were employed at the discretion of the attending physician. As the CYCAZAREM, WEGENT (Wegener’s granulomatosis-entretien trial) [19], and IMPROVE (international mycophenolate protocol to reduce outbreaks of vasculitides randomized trial) trials [20] have indicated that azathioprine is the best adjunctive immunosuppressant during maintenance treatment, the use of this agent for MPA patients should be analyzed in future trials. In addition, a tapering protocol was not determined in the JMAAV trial, and therefore the total amounts of glucocorticoid administered were greater than those outlined in the European recommendations (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study

et al. 2011

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We (JMAAV [Japanese patients with MPO-ANCA-associated vasculitis] Study Group) performed a prospective, open-label, multi-center trial to evaluate the usefulness of severity-based treatment in Japanese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibodies (MPO-ANCA)-associated vasculitis. Patients with MPO-ANCA-associated vasculitis received a severity-based regimen according to the appropriate protocol: low-dose corticosteroid and, if necessary, cyclophosphamide or azathioprine in patients with mild form; high-dose corticosteroid and cyclophosphamide in those with severe form; and the severe-form regimen plus plasmapheresis in those with the most severe form. We followed up the patients for 18 months. The primary end points were the induction of remission, death, and end-stage renal disease (ESRD). Fifty-two patients were registered, and 48 patients were enrolled in this study (mild form, n = 23; severe form, n = 23; most severe form, n = 2). Among the 47 patients who received the predefined therapies, 42 achieved remission within 6 months, 5 died, and 1 developed ESRD. Disease flared up in 8 of the 42 patients with remission during the 18-month follow-up period. The JMAAV trial is the first prospective trial for MPO-ANCA-associated vasculitis to be performed in Japan. The remission and death rates were comparable to those in several previous clinical trials performed in western counties. The regimen employed in this trial was tailor-made based on patients’ disease severity and disease type, and it seems that standardization can be consistent with treatment choices made according to severity.

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Section: Discussionmentioning

confidence: 99%

Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study

et al. 2011

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“…Bosch et al reported that azathioprine and daily prednisone can maintain remission in patients who test negative for ANCAs, whereas patients positive for PR3 ANCA should be closely monitored because of a higher probability of relapse (28). Methotrexate has been shown to be equivalent to azathioprine, but it should not be used in patients with renal impairment (45). How long to continue maintenance therapy is not known, but at least 1 year since remission is recommended.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Hematuria

Najem

Sfeir

Estrada

et al. 2014

Arthritis Care & Research

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“…B. dem Protokoll der sog. WEGENTStudie [179]. Auch die remissionserhaltende Behandlung mit RTX nach Induktion mit CYC wurde gemäß Studienprotokoll nicht später als 4 Wochen nach der letzten CYC-Gabe begonnen [68].…”

Section: Remissionserhaltende Therapie Nach Induktion Mit Cyclophosphunclassified

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

Schirmer

Moosig²

2017

Z Rheumatol

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Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

Cited by 601 publications

References 26 publications

Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study

Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study

An Unusual Case of Hematuria

S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis

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