TREATMENT OF GOOD-PROGNOSIS POLYARTERITIS-NODOSA AND CHURG-STRAUSS-SYNDROME - COMPARISON OF STEROIDS AND ORAL OR PULSE CYCLOPHOSPHAMIDE IN 25 PATIENTS

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 cyclop hosphamide (CY; 2 mg/kg/day) for yr (group A), or oral corticosteroids and monthly i.v. CY pulses (0.6 g/m(2)) (group B) for 1 yr. The objec tive was to determine the optimal CY regimen. Judgement criteria were the efficacy of the treatment in controlling the disease and the devel opment of side-effects. Among the 25 patients who could be analysed, c omplete recovery was achieved with the experimental treatment in 9/12 patients in group A and 10/13 patients in group B. Two patients in eac h group relapsed after the end of therapy and were well controlled by corticosteroids or other drugs. One failure occurred in each group. Th e mean follow-up was 60.8 +/- 14.5 months after the beginning of the t reatment. Side-effects associated with the administration of CY and st eroids were noted 27 times in group A vs 14 times in group B (not sign ificant). The oldest patient in these series (group B) died of pneumon ia. No superiority in terms of efficacy could be established between t he two regimens; however, the number of patients included was too smal l 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 dose s of immunosuppression.