Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis
Induction therapy with oral cyclophosphamide (CYP) has been a mainstay of treatment in patients with severe renal failure secondary to ANCA-associated vasculitis (AAV). Recent evidence proposes using pulsed intravenous CYP in less severe disease to minimize adverse events. It is unclear if this can...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2013-02, Vol.8 (2), p.219-224 |
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| container_title | Clinical journal of the American Society of Nephrology |
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| creator | Pepper, Ruth J Chanouzas, Dimitrios Tarzi, Ruth Little, Mark A Casian, Alina Caisian, Alina Walsh, Michael Pusey, Charles D Harper, Lorraine Salama, Alan D |
| description | Induction therapy with oral cyclophosphamide (CYP) has been a mainstay of treatment in patients with severe renal failure secondary to ANCA-associated vasculitis (AAV). Recent evidence proposes using pulsed intravenous CYP in less severe disease to minimize adverse events. It is unclear if this can be translated to those with dialysis-dependent renal insufficiency.
All AAV patients presenting between 2005 and 2010 requiring dialysis at presentation were retrospectively analyzed. Patients were treated with plasma exchange, corticosteroids, and intravenous CYP. Rate of dialysis independence at 3 and 12 months and adverse effects were assessed and compared with the outcome of the plasmapheresis, prednisolone, and oral CYP arm of the randomized MEPEX (methylprednisolone versus plasma exchange) trial.
Forty-one patients were included. At 3 months, 3 (7.3%) patients had died on dialysis, 12 (29.3%) remained dialysis dependent, and 26 (63.4%) were dialysis independent (creatinine, 2.5 mg/dl; GFR, 26 ml/min per 1.73 m(2)). Four patients subsequently reached ESRD at a median time of 83 days. Thirty-seven (90%) patients reached 1 year follow-up, 13 (35%) remained dialysis dependent, and 24 (65%) had independent renal function. Eleven patients (27%) had episodes of leukopenia (white cell count |
| doi_str_mv | 10.2215/CJN.03680412 |
| format | Article |
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All AAV patients presenting between 2005 and 2010 requiring dialysis at presentation were retrospectively analyzed. Patients were treated with plasma exchange, corticosteroids, and intravenous CYP. Rate of dialysis independence at 3 and 12 months and adverse effects were assessed and compared with the outcome of the plasmapheresis, prednisolone, and oral CYP arm of the randomized MEPEX (methylprednisolone versus plasma exchange) trial.
Forty-one patients were included. At 3 months, 3 (7.3%) patients had died on dialysis, 12 (29.3%) remained dialysis dependent, and 26 (63.4%) were dialysis independent (creatinine, 2.5 mg/dl; GFR, 26 ml/min per 1.73 m(2)). Four patients subsequently reached ESRD at a median time of 83 days. Thirty-seven (90%) patients reached 1 year follow-up, 13 (35%) remained dialysis dependent, and 24 (65%) had independent renal function. Eleven patients (27%) had episodes of leukopenia (white cell count <4×10(9)/L) during CYP therapy and 17 (41%) experienced infectious complications. This compares favorably with the dialysis-dependent cohort treated with plasmapheresis in the MEPEX study in which 51% were alive with independent renal function at 1 year.
Intravenous CYP used with corticosteroids and plasmapheresis may be an effective alternative to oral CYP in patients with dialysis-dependent AAV.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.03680412</identifier><identifier>PMID: 23160261</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy ; Combined Modality Therapy ; Cyclophosphamide - administration & dosage ; Female ; Humans ; Immunosuppressive Agents - administration & dosage ; Injections, Intravenous ; Male ; Middle Aged ; Original ; Plasmapheresis ; Renal Dialysis ; Retrospective Studies ; Young Adult</subject><ispartof>Clinical journal of the American Society of Nephrology, 2013-02, Vol.8 (2), p.219-224</ispartof><rights>Copyright © 2013 by the American Society of Nephrology 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-761c55b48713772cd5046f4e9f388ed8d260415fde2596f85000537528452bf53</citedby><cites>FETCH-LOGICAL-c481t-761c55b48713772cd5046f4e9f388ed8d260415fde2596f85000537528452bf53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562855/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562855/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23160261$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pepper, Ruth J</creatorcontrib><creatorcontrib>Chanouzas, Dimitrios</creatorcontrib><creatorcontrib>Tarzi, Ruth</creatorcontrib><creatorcontrib>Little, Mark A</creatorcontrib><creatorcontrib>Casian, Alina</creatorcontrib><creatorcontrib>Caisian, Alina</creatorcontrib><creatorcontrib>Walsh, Michael</creatorcontrib><creatorcontrib>Pusey, Charles D</creatorcontrib><creatorcontrib>Harper, Lorraine</creatorcontrib><creatorcontrib>Salama, Alan D</creatorcontrib><creatorcontrib>European Vasculitis Study (EUVAS) investigators</creatorcontrib><title>Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>Induction therapy with oral cyclophosphamide (CYP) has been a mainstay of treatment in patients with severe renal failure secondary to ANCA-associated vasculitis (AAV). Recent evidence proposes using pulsed intravenous CYP in less severe disease to minimize adverse events. It is unclear if this can be translated to those with dialysis-dependent renal insufficiency.
All AAV patients presenting between 2005 and 2010 requiring dialysis at presentation were retrospectively analyzed. Patients were treated with plasma exchange, corticosteroids, and intravenous CYP. Rate of dialysis independence at 3 and 12 months and adverse effects were assessed and compared with the outcome of the plasmapheresis, prednisolone, and oral CYP arm of the randomized MEPEX (methylprednisolone versus plasma exchange) trial.
Forty-one patients were included. At 3 months, 3 (7.3%) patients had died on dialysis, 12 (29.3%) remained dialysis dependent, and 26 (63.4%) were dialysis independent (creatinine, 2.5 mg/dl; GFR, 26 ml/min per 1.73 m(2)). Four patients subsequently reached ESRD at a median time of 83 days. Thirty-seven (90%) patients reached 1 year follow-up, 13 (35%) remained dialysis dependent, and 24 (65%) had independent renal function. Eleven patients (27%) had episodes of leukopenia (white cell count <4×10(9)/L) during CYP therapy and 17 (41%) experienced infectious complications. This compares favorably with the dialysis-dependent cohort treated with plasmapheresis in the MEPEX study in which 51% were alive with independent renal function at 1 year.
Intravenous CYP used with corticosteroids and plasmapheresis may be an effective alternative to oral CYP in patients with dialysis-dependent AAV.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy</subject><subject>Combined Modality Therapy</subject><subject>Cyclophosphamide - administration & dosage</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Injections, Intravenous</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Plasmapheresis</subject><subject>Renal Dialysis</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkE1PwkAQhjdGI4jePJuePFncr2mXiwkpfmAIelDjbV12t3RJaZtuwfDvLUGInmaSeeadzIPQJcF9SgncJs_TPmaRwJzQI9QlABAOMHweH3pOOujM-wXGnDMKp6hDGYkwjUgXfY2LplZrW5QrHyQbnZdVVvoqU0tnbKAKE7zmyi9VldnaeucDVwQjp_JN24cjW9nC2KIJhtNkGA69L7VTjTXBh_J6lbvG-XN0kqrc24vf2kPvD_dvyVM4eXkcJ8NJqLkgTRhHRAPMuIgJi2OqDWAepdwOUiaENcLQqP0DUmMpDKJUAMYYWAxUcKCzFFgP3e1yq9VsaY22279yWdVuqeqNLJWT_yeFy-S8XEsGERWwDbjZBei69L626WGXYLk1LVvTcm-6xa_-3jvAe7UtcL0DMjfPvl1tZasxz1ucSr1QvhCSSkoG7AeKW4fn</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Pepper, Ruth J</creator><creator>Chanouzas, Dimitrios</creator><creator>Tarzi, Ruth</creator><creator>Little, Mark A</creator><creator>Casian, Alina</creator><creator>Caisian, Alina</creator><creator>Walsh, Michael</creator><creator>Pusey, Charles D</creator><creator>Harper, Lorraine</creator><creator>Salama, Alan D</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20130201</creationdate><title>Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis</title><author>Pepper, Ruth J ; Chanouzas, Dimitrios ; Tarzi, Ruth ; Little, Mark A ; Casian, Alina ; Caisian, Alina ; Walsh, Michael ; Pusey, Charles D ; Harper, Lorraine ; Salama, Alan D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-761c55b48713772cd5046f4e9f388ed8d260415fde2596f85000537528452bf53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy</topic><topic>Combined Modality Therapy</topic><topic>Cyclophosphamide - administration & dosage</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Injections, Intravenous</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Plasmapheresis</topic><topic>Renal Dialysis</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pepper, Ruth J</creatorcontrib><creatorcontrib>Chanouzas, Dimitrios</creatorcontrib><creatorcontrib>Tarzi, Ruth</creatorcontrib><creatorcontrib>Little, Mark A</creatorcontrib><creatorcontrib>Casian, Alina</creatorcontrib><creatorcontrib>Caisian, Alina</creatorcontrib><creatorcontrib>Walsh, Michael</creatorcontrib><creatorcontrib>Pusey, Charles D</creatorcontrib><creatorcontrib>Harper, Lorraine</creatorcontrib><creatorcontrib>Salama, Alan D</creatorcontrib><creatorcontrib>European Vasculitis Study (EUVAS) investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pepper, Ruth J</au><au>Chanouzas, Dimitrios</au><au>Tarzi, Ruth</au><au>Little, Mark A</au><au>Casian, Alina</au><au>Caisian, Alina</au><au>Walsh, Michael</au><au>Pusey, Charles D</au><au>Harper, Lorraine</au><au>Salama, Alan D</au><aucorp>European Vasculitis Study (EUVAS) investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>8</volume><issue>2</issue><spage>219</spage><epage>224</epage><pages>219-224</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>Induction therapy with oral cyclophosphamide (CYP) has been a mainstay of treatment in patients with severe renal failure secondary to ANCA-associated vasculitis (AAV). Recent evidence proposes using pulsed intravenous CYP in less severe disease to minimize adverse events. It is unclear if this can be translated to those with dialysis-dependent renal insufficiency.
All AAV patients presenting between 2005 and 2010 requiring dialysis at presentation were retrospectively analyzed. Patients were treated with plasma exchange, corticosteroids, and intravenous CYP. Rate of dialysis independence at 3 and 12 months and adverse effects were assessed and compared with the outcome of the plasmapheresis, prednisolone, and oral CYP arm of the randomized MEPEX (methylprednisolone versus plasma exchange) trial.
Forty-one patients were included. At 3 months, 3 (7.3%) patients had died on dialysis, 12 (29.3%) remained dialysis dependent, and 26 (63.4%) were dialysis independent (creatinine, 2.5 mg/dl; GFR, 26 ml/min per 1.73 m(2)). Four patients subsequently reached ESRD at a median time of 83 days. Thirty-seven (90%) patients reached 1 year follow-up, 13 (35%) remained dialysis dependent, and 24 (65%) had independent renal function. Eleven patients (27%) had episodes of leukopenia (white cell count <4×10(9)/L) during CYP therapy and 17 (41%) experienced infectious complications. This compares favorably with the dialysis-dependent cohort treated with plasmapheresis in the MEPEX study in which 51% were alive with independent renal function at 1 year.
Intravenous CYP used with corticosteroids and plasmapheresis may be an effective alternative to oral CYP in patients with dialysis-dependent AAV.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>23160261</pmid><doi>10.2215/CJN.03680412</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1555-9041 |
| ispartof | Clinical journal of the American Society of Nephrology, 2013-02, Vol.8 (2), p.219-224 |
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| language | eng |
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| subjects | Adult Aged Aged, 80 and over Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy Combined Modality Therapy Cyclophosphamide - administration & dosage Female Humans Immunosuppressive Agents - administration & dosage Injections, Intravenous Male Middle Aged Original Plasmapheresis Renal Dialysis Retrospective Studies Young Adult |
| title | Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis |
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