RESPONSE TO TRIMETHOPRIM-SULFAMETHOXAZOLE IN WEGENERS GRANULOMATOSIS DEPENDS ON THE PHASE OF DISEASE

We prospectively studied trimethoprim/sulfamethoxazole (T/S) in induci ng remission in 'initial phase' Wegener's granulomatosis (WG), and in sustaining remission in generalized WC, in 72 patients in various dise ase stages. Nineteen patients with initial phase WG received T/S (2 x 960 mg/day). Another 24 patients with generalized WC received the same dose of T/S (group A) and were compared with 21 patients receiving no further treatment after standard therapy (group B). Eight patients we re given T/S plus low-dose prednisone (group C). Eleven of 19 patients (58%) with initial phase WC achieved complete or partial remission la sting a median 43 months (range 6-88 months). Of the remaining eight ( 42%), five showed local disease progression, and three developed gener alized WG. In group A (T/S alone, generalized WC), 10/24 (42%) suffere d a relapse after a median 13 months (range 4-58 months). In group B ( generalized WC, no further treatment) 29% of patients relapsed after a median 22.5 months (range 18-26 months). All eight patients treated w ith T/S plus low-dose prednisone (group C) suffered serious relapse af ter 2-24 months. T/S induced long-term remission in > 50% of patients with initial phase WG; however, neither T/S alone nor T/S plus low-dos e prednisone sustained remission in generalized WG.