Maintenance Therapy for ANCA-associated Vasculitis






Current remission maintenance therapies for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) are limited by partial efficacy and toxicity.

The IMPROVE trial, a multicenter trial, demonstrated that mycophenolate mofetil was less effective than azathioprine for maintaining disease remission among 156 patients with newly diagnosed ANCA-associated vasculitis.

After induction of remission with cyclophosphamide and glucocorticoids, patients received either azathioprine (starting at 2 mg/kg per day, then reduced to 1.5 and 1.0 mg/kg per day after 12 and 18 months, respectively) or MMF (starting at 2000 mg per day and reduced to 1500 and 1000 mg per day after 12 and 18 months respectively). Both agents were withdrawn after 42 months of treatment. At a median follow-up of 39 months, relapses were significantly less frequent among those who received azathioprine (38 versus 55 percent, adjusted hazard ratio 0.56, 95% CI 0.34-0.91).

The rate of adverse events was not significantly different for those who received azathioprine (16 versus 8 percent, respectively).


Keywords: 
antibodies, antineutrophil cytoplasmic, azathioprine, drug reaction, adverse, inflammation, mycophenolate mofetil, patient safety, randomized trials, recurrence, survival, vasculitis.

Source: 
Hiemstra TF, Walsh M, Mahr A, et al. Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized controlled trial. JAMA 2010; 304:2381.
 

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