Featured Research

from universities, journals, and other organizations

Drug regarded as alternative to standard treatment for preventing relapse of certain type of vasculitis does not appear as effective

Date:
November 8, 2010
Source:
JAMA and Archives Journals
Summary:
In a comparison of treatments for maintaining remission of a certain type of vasculitis (inflammation of blood vessels), the immunosuppressant mycophenolate mofetil, regarded as an alternative to the drug often used to prevent relapse, azathioprine, was less effective, according to a new study.

In a comparison of treatments for maintaining remission of a certain type of vasculitis (inflammation of blood vessels), the immunosuppressant mycophenolate mofetil, regarded as an alternative to the drug often used to prevent relapse, azathioprine, was less effective, according to a study that will appear in the December 1 print edition of JAMA. The study is being released early online to coincide with its presentation at the American College of Rheumatology annual scientific meeting.

Related Articles


"Relapses of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) occur in 50 percent of patients within 5 years of diagnosis, and treatment toxicity is common. Safe and effective therapies to maintain remission of AAV are a priority," the authors write. "In AAV, small observational studies and randomized controlled trials reported successful remission induction and remission maintenance with mycophenolate mofetil. Whether mycophenolate mofetil is more effective than azathioprine [an immunosuppressive] for preventing relapses in AAV is uncertain."

Thomas F. Hiemstra, M.D., M.R.C.P., of the University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, England, and colleagues examined whether mycophenolate mofetil reduces the risk of relapse compared with azathioprine in patients with AAV in remission, and compared the risk of serious adverse events between treatment groups. The randomized trial was conducted at 42 centers in 11 European countries between April 2002 and January 2009. Eligible patients had newly diagnosed AAV and were ages 18 to 75 years at diagnosis. Patients were randomly assigned to receive azathioprine or mycophenolate mofetil after induction of remission with the agents cyclophosphamide and prednisolone.

A total of 156 patients were assigned to azathioprine (n = 80) or mycophenolate mofetil (n = 76) and were followed up for a median (midpoint) of 39 months. The researchers found that relapses were more common in the mycophenolate mofetil group (42/76 patients; 18 with major and 24 with minor relapses) compared with the azathioprine group (30/80 patients; 10 with major and 20 with minor relapses).

Severe adverse events did not differ significantly between groups, with 22 severe adverse events in 13 patients (16 percent) in the azathioprine group and 8 severe adverse events in 8 patients (7.5 percent) in the mycophenolate mofetil group. There were 8 severe infections in 8 patients in the azathioprine group and 3 severe infections in 3 patients in the mycophenolate mofetil group.

The secondary outcomes of Vasculitis Damage Index, estimated glomerular filtration rate (a measure of kidney function), and proteinuria (the presence of excessive protein in the urine) did not differ significantly between groups.

"Although mycophenolate mofetil is frequently regarded as a potent alternative to azathioprine, we found no evidence to support its use as the initial remission maintenance therapy for patients with AAV," the authors write.

Editorial: Therapeutic Interventions for Systemic Vasculitis

In an accompanying editorial, Gary S. Hoffman, M.D., M.S., of the Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, writes that at this time, several key therapeutic findings regarding vasculitis research are apparent.

"Remission maintenance therapies (methotrexate, azathioprine) are as effective as prolonged cyclophosphamide and are much safer. Mycophenolate mofetil is associated with a higher relapse rate than azathioprine. Discontinuation of maintenance therapies appears to be associated with a higher rate of relapse than continuation of treatment. However, the risk-benefit formulas of long-term maintenance therapy vs. discontinuation and treatment of relapses require further study. Ideally these questions can be addressed by clinical trials of similar quality and importance as the report by Hiemstra et al and other major contributions of the European Vasculitis Study Group."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Thomas F. Hiemstra; Michael Walsh; Alfred Mahr; Caroline O. Savage; Kirsten de Groot; Lorraine Harper; Thomas Hauser; Irmgard Neumann; Vladimir Tesar; Karl-Martin Wissing; Christian Pagnoux; Wilhelm Schmitt; David R. W. Jayne; for the European Vasculitis Study Group (EUVAS). Mycophenolate Mofetil vs Azathioprine for Remission Maintenance in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Randomized Controlled Trial. JAMA, 2010; DOI: 10.1001/jama.2010.1658
  2. Gary S. Hoffman. Therapeutic Interventions for Systemic Vasculitis. JAMA, 2010; 0 (2010): jama. 2010. 1676 DOI: 10.1001/jama.2010.1676

Cite This Page:

JAMA and Archives Journals. "Drug regarded as alternative to standard treatment for preventing relapse of certain type of vasculitis does not appear as effective." ScienceDaily. ScienceDaily, 8 November 2010. <www.sciencedaily.com/releases/2010/11/101108171537.htm>.
JAMA and Archives Journals. (2010, November 8). Drug regarded as alternative to standard treatment for preventing relapse of certain type of vasculitis does not appear as effective. ScienceDaily. Retrieved December 21, 2014 from www.sciencedaily.com/releases/2010/11/101108171537.htm
JAMA and Archives Journals. "Drug regarded as alternative to standard treatment for preventing relapse of certain type of vasculitis does not appear as effective." ScienceDaily. www.sciencedaily.com/releases/2010/11/101108171537.htm (accessed December 21, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, December 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Touch-Free Smart Phone Empowers Mobility-Impaired

Touch-Free Smart Phone Empowers Mobility-Impaired

Reuters - Innovations Video Online (Dec. 21, 2014) A touch-free phone developed in Israel enables the mobility-impaired to operate smart phones with just a movement of the head. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Earthworms Provide Cancer-Fighting Bacteria

Earthworms Provide Cancer-Fighting Bacteria

Reuters - Innovations Video Online (Dec. 21, 2014) Polish scientists isolate bacteria from earthworm intestines which they say may be used in antibiotics and cancer treatments. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Existing Chemical Compounds Could Revive Failing Antibiotics, Says Danish Scientist

Existing Chemical Compounds Could Revive Failing Antibiotics, Says Danish Scientist

Reuters - Innovations Video Online (Dec. 21, 2014) A team of scientists led by Danish chemist Jorn Christensen says they have isolated two chemical compounds within an existing antipsychotic medication that could be used to help a range of failing antibiotics work against killer bacterial infections, such as Tuberculosis. Jim Drury went to meet him. Video provided by Reuters
Powered by NewsLook.com
Hugging It Out Could Help You Ward Off A Cold

Hugging It Out Could Help You Ward Off A Cold

Newsy (Dec. 21, 2014) Carnegie Mellon researchers found frequent hugs can help people avoid stress-related illnesses. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins