Rheumatology 2003; 42: 396-397
© 2003 British Society for Rheumatology
Letters to the Editor |
Reply
St Thomas' Hospital, Lupus Research Unit, The Rayne Institute, London, UK
We would first like to acknowledge the undoubted pre-eminence of Dr DeRemee in the use of Septrin (sulphamethoxazole–trimethoprim) monotherapy in limited Wegener's granulomatosis (WG) [1, 2].
Our aim was to highlight the potential efficacy of such treatment, by describing the successful use of Septrin monotherapy in our patient. We still consider that our case was worthy of reporting, given that at no point did she receive corticosteroid or cytotoxic therapy, and that she has remained in remission for a period of 96 months, despite evidence of persistent immune activation suggested by a positive antineutrophil cytoplasmic antibody (c-ANCA) immunofluorescence and proteinase 3 (PR3) antibody >100 U/ml.
Some of the studies concerning Septrin in WG have examined the effect of Septrin as adjunctive therapy [3], whilst in other reports it might be difficult to assess the effect of Septrin because of corticosteroid or cytotoxic therapy received at other times during the disease course [4]. The studies of DeRemee [1, 2] and of Reinhold-Keller et al. [5] are notable for their clear reporting of the effects of Septrin monotherapy. Some authors, such as Hoffman et al. [4], remain to be convinced of its efficacy even in limited disease.
Whilst efficacy using Septrin as adjunctive therapy has been shown in a controlled trial in WG [3], perhaps further studies still need to be performed with Septrin monotherapy in limited WG.
Notes
Correspondence to: D. P. D'Cruz. E-mail: yousuf.karim{at}gstt.sthames.nhs.uk 
References
- DeRemee RA, McDonald TJ, Weiland LH. Wegener's granulomatosis: observations on treatment with antimicrobial agents. Mayo Clin Proc 1985;60:27–32.[Web of Science][Medline]
- DeRemee RA. The treatment of Wegener's granulomatosis with trimethoprim/sulfamethoxazole: illusion or vision? Arthritis Rheum 1988;31:1068–74.[Medline]
- Stegeman CA, Tervaert JWC, de Jong PE, Kallenberg CGM. Trimethoprim-sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Wegener's granulomatosis. N Engl J Med 1996;335:16–20.
[Abstract/Free Full Text] - Hoffman GS. Immunosuppressive therapy is always required for the treatment of limited Wegener's granulomatosis. Sarcoidosis Vasc Diffuse Lung Dis 1996;13:249–52.[Medline]
- Reinhold-Keller E, De Groot K, Rudert H, Nolle B, Heller M, Gross WL. Response to trimethoprim/sulfamethoxazole in Wegener's granulomatosis depends on the phase of disease. Q J Med 1996;89:15–23.
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