The treatment of wegener's granulomatosis with trimethoprim/sulfamethoxazole: illusion or vision?

DeRemee, Richard A.

doi:10.1002/art.1780310821

Cited by 148 publications

(41 citation statements)

References 14 publications

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“…aureus colonizes the upper airways in about 20% of healthy persons. Most patients with serious sinus or nasal disease due to WG develop secondary infections, in which S. aureus is predominantly involved [1][2][3][4][5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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Association between Wegener's granulomatosis and Staphylococcus aureus infection?

Putten¹,

Haren²,

Lammers³

1996

Eur Respir J

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A As ss so oc ci ia at ti io on n b be et tw we ee en n W We eg ge en ne er r' 's s g gr ra an nu ul lo om ma at to os si is s a an nd d S St ta ap ph hy yl lo oc co oc cc cu us s a au ur re eu us s i in nf fe ec ct ti io on n? ? We suggest that bronchoalveolar lavages should be performed in cases of suspected WG to identify SA-infections. The co-existence of WG and SA support the reported beneficial effects of sulfamethoxazole/trimethoprim, but needs further evaluation in patients with and without SA-infection of the airways.

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Section: Discussionmentioning

confidence: 99%

“…This has prompted the search for a less toxic treatment regimen in limited disease. Several reports have noted good results following treatment with trimethoprim/sulphamethoxazole [2][3][4][5]. This has given rise to a suspicion of the possible involvement of an infectious agent in the pathogenesis of WG.…”

mentioning

confidence: 98%

Association between Wegener's granulomatosis and Staphylococcus aureus infection?

Putten¹,

Haren²,

Lammers³

1996

Eur Respir J

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“…Furthermore, patients could be entered in two existing studies for 'localised' Wegener's granulomatosis, and Churg Strauss angiilis and ployarteritis nodosa (Table 3). They share overlapping inclusion and exclusion criteria and trealment limbs and form a eoniinnuum covering the entire spectrum of new presentations of these disorders, MAYO -Participation in an existing trial ofWegener's granulomatosis limited to the upper and/or lower respiratory tract comparing steroids alone to sulfamethoxazole/irimethoprim for twelve months (coordinator, Dr Ulrich Specks, Mayo Clinic, USA) [11].…”

Section: Pementioning

confidence: 99%

European therapeutic trials in ANCA-associated systemic vasculitis: disease scoring, consensus regimens and proposed clinical trials EUROPEAN COMMUNITY STUDY GROUP ON CLINICAL TRIALS IN SYSTEMIC VASCULITIS ECSYSVASTRIAL (BMHl-Cr93-1078)

Rasmussen¹,

Jayne²,

Abramowicz³

et al. 1995

Clinical and Experimental Immunology

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In previous phases of this project, proteinase 3 (PR3) and myeloperoxidase (MPO), the main antigenic target molecules of antineutrophil cytopiasmic antibodies, were isolated and applied in standardized ELISAs.In this study, standardized ELISAs with three PR3 preparations (from Copenhagen (CO), Raisdorf (RS) and Leiden (LF)) and one MPO preparation (from Copenhagen), were evaluated in a large retro-and prospective clitiical study.New patients (n=174) with primary systemic vasculitis (Wegener's granulomatosis, microscopic polyangiitis and idiopathic rapidly progressive glomerulonephritis, classical PAN and Churg-Strauss Syndrome) were included. Retrospectively, another 190 patients were evaluated. Furthermore control sera were obtained from patients with other forms of vasculitis, glomerulonephritis or granulomatous diseases (disease controls, n = 184) and healthy donors (healthy controls, n = 728). All patients were categorized by a system based on clinical and histoiogical data. Patients were followed up for at least 1 year after diagnosis in order to evaluate a possible correlation between ANCA levels and disease activity.The sensitivity of the anti-PR3 assays for histologically proven WG was between 59% and 69% in new patients, with a sensitivity of 22% for the anti-MPO assay. Similar figures were found for patients with clinically suspected WG. This was comparable with the results of the IIF test. In MPA and IRPGN a larger percentage of patients had anti-MPO antibodies than in WG. Only a few patients with PAN and CSS were investigated, and most of these were negative in the ELISAs.The specificity ofthe assays for disease controls was 89-91% for the anti-PR3 assays and 95% for the anti-MPO assay. In the healthy controls the specificity was 98-99%. The specificity of the IIF test was 97% for a cANCA pattern and 81 % for a pANCA pattern in disease controls. The combination of cANCA with anti-PR3 and pANCA with anti-MPO both had a specificity of 99%.Further details will be presented during the meeting, in addition to the results of a follow-up study with correlation ofdisease activity and ANCA level. From this study we can conclude that ELISAs using purified PR3 or MPO are not more sensitive than the IIF test. However, the anti-MPO assay is more specific for systemic vascuitis as compared to disease controls with related diseases. Furthermore, the combination of the IIF test with antigen-specific ELISAs is very specific for the diagnosis Wegetier's granulomatosis, microscopic polyangiitis and idiopathic rapidly progressive gtomerulonephritis.

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“…Whether this attenuated course was to some extent an incomplete response to intermittent antimicrobial treatment is speculative, but treatment with cotrimoxazole has been reported to be effective in limited WG, i.e. when only the lungs are involved [20][21][22].…”

Section: Commentmentioning

confidence: 99%

Late recurrence of Wegener's granulomatosis presenting as solitary upper lobe pulmonary mass

Werf¹,

Stegeman²,

Meuzelaar³

et al. 1994

Eur Respir J

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L La at te e r re ec cu ur rr re en nc ce e o of f W We eg ge en ne er r' 's s g gr ra an nu ul lo om ma at to os si is s p pr re es se en nt ti in ng g a as s s so ol li it ta ar ry y u up pp pe er r l lo ob be e p pu ul lm mo on na ar ry y m ma as ss s Eight years previously, a first episode of WG involving the upper airways and kidneys, but not the lungs, had been successfully treated with prednisolone and cyclophosphamide, which could be stopped after 2 yrs. The antineutrophil cytoplasmic antibody titres (anti-protease 3), which had been very high during the first disease episode, failed to predict the recurrence.

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The treatment of wegener's granulomatosis with trimethoprim/sulfamethoxazole: illusion or vision?

Cited by 148 publications

References 14 publications

Association between Wegener's granulomatosis and Staphylococcus aureus infection?

Association between Wegener's granulomatosis and Staphylococcus aureus infection?

European therapeutic trials in ANCA-associated systemic vasculitis: disease scoring, consensus regimens and proposed clinical trials EUROPEAN COMMUNITY STUDY GROUP ON CLINICAL TRIALS IN SYSTEMIC VASCULITIS ECSYSVASTRIAL (BMHl-Cr93-1078)

Late recurrence of Wegener's granulomatosis presenting as solitary upper lobe pulmonary mass

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