INDUCTION OF REMISSION IN WEGENERS GRANULOMATOSIS WITH LOW-DOSE METHOTREXATE

Objective. To study the efficacy of methotrexate (MTX) plus low dose c orticosteroids for induction of remission in generalized Wegener's gra nulomatosis (WG) and to possibly identify predictive factors for the o utcome under this therapy. Methods. We conducted a prospective, open l abel study, including 17 patients with not immediately life threatenin g, generalized WG, Treatment consisted of intravenous MTX 0.3 mg/kg on ce weekly plus daily oral low dose prednisone for initial diagnosis of WC in 11 and for a generalized relapse of WG in 6 patients. Interdisc iplinary, standardized assessments of disease activity and extent were done 3-monthly. Results. Within a median treatment period of 24.5 mon ths remission could be achieved in 10/17 patients (59%), their median corticosteroid dose during that time was 1.75 mg/day, Seven patients w ith a median concomitant prednisone dose of 7.5 mg/day did not respond , among them 4 patients who were treated for a relapse of WG. Signs of de novo glomerulonephritis occurred in 5 of the 7 nonresponders. Sign ificant side effects, including opportunistic infections, did not occu r. Conclusion. Weekly low dose MTX in combination with low dose cortic osteroids leads to an acceptable remission rate of almost 60% without significant side effects. Patients treated for a relapse of WG and pat ients with a need for a higher concomitant prednisone dose seem to be at risk for nonresponse, with a high likelihood of developing de novo glomerulonephritis.