The British Journal of Rheumatology, Vol 36, 1290-1297, Copyright © 1997 by British Society for Rheumatology
M Gayraud, L Guillevin, P Cohen, F Lhote, P Cacoub, P Deblois, B Godeau, M Ruel, E Vidal, M Piontud, JP Ducroix, S Lassoued, B Christoforov and P Babinet
Twenty-five patients with good-prognosis polyarteritis nodosa or Churg-
Strauss syndrome entered a prospective, randomized, multicentre study
comparing two treatments: either oral corticosteroids and oral
cyclophosphamide (CY; 2 mg/kg/day) for 1 yr (group A), or oral
corticosteroids and monthly i.v. CY pulses (0.6 g/m2) (group B) for 1 yr.
The objective was to determine the optimal CY regimen. Judgement criteria
were the efficacy of the treatment in controlling the disease and the
development of side-effects. Among the 25 patients who could be analysed,
complete recovery was achieved with the experimental treatment in 9/12
patients in group A and 10/13 patients in group B. Two patients in each
group relapsed after the end of therapy and were well controlled by
corticosteroids or other drugs. One failure occurred in each group. The
mean follow-up was 60.8 +/- 14.5 months after the beginning of the
treatment. Side-effects associated with the administration of CY and
steroids were noted 27 times in group A vs 14 times in group B (not
significant). The oldest patient in these series (group B) died of
pneumonia. No superiority in terms of efficacy could be established between
the two regimens; however, the number of patients included was too small to
conclude definitively. Toxic side- effects were significantly more frequent
in women (P < 0.02). The high number of adverse effects leads us to
recommend pulse over oral CY and an overall lowering of the doses of
immunosuppression.
ORIGINAL PAPERS
Treatment of good-prognosis polyarteritis nodosa and Churg-Strauss syndrome: comparison of steroids and oral or pulse cyclophosphamide in 25 patients. French Cooperative Study Group for Vasculitides
Department of Internal Medicine, Hopital Avicenne, Universite Paris- Nord, Bobigny, France.
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