Landmark Trials in ANCA Nephritis

CYCLOPS 2009

Pulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis.

The pulse cyclophosphamide regimen induced remission of ANCA-associated vasculitis as well as the daily oral regimen at a reduced cumulative cyclophosphamide dose and caused fewer cases of leukopenia.

2011

Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis:

long-term follow-up

Pulse cyclophosphamide is associated with a higher relapse risk than daily oral cyclophosphamide. However, this is not associated with increased mortality or long-term morbidity. Although the study was retrospective, data was returned in 90% of patients from the original trial.

CYCAZAREM 2003

A Randomized Trial of Maintenance Therapy for Vasculitis Associated with Antineutrophil Cytoplasmic Autoantibodies

In patients with generalized vasculitis, the withdrawal of cyclophosphamide and the substitution of azathioprine after remission did not increase the rate of relapse. Thus, the duration of exposure to cyclophosphamide may be safely reduced.

WEGENT 2008

Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

These results do not support the primary hypothesis that methotrexate is safer than azathioprine.

The two agents appear to be similar alternatives for maintenance therapy in patients with Wegener’s granulomatosis and microscopic polyangiitis after initial remission.

IMPROVE 2010

Mycophenolate Mofetil vs Azathioprine for Remission Maintenance in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis.

Among patients with AAV, mycophenolate mofetil was less effective than azathioprine for maintaining disease remission. Both treatments had similar adverse event rates.