CYCLOSPORINE FOR THE PREVENTION OF DISEASE REACTIVATION IN RELAPSING ANCA-ASSOCIATED VASCULITIS

Background. In patients with ANCA-associated vasculitis the frequent d evelopment of relapses after successful initial treatment remains a ma jor therapeutic problem. Thus a long-term prophylactic therapy with lo w side-effect potential is needed. As recent data suggest an involveme nt of T cells in the pathogenesis of ANCA-associated vasculitis, the p rophylactic value of therapy with low-dose cyclosporin was investigate d in seven patients (three with Wegener's granulomatosis, four with mi croscopic polyangiitis, all with renal involvement) who had developed at least one relapse during cyclophosphamide (CP) treatment or in the first 4 months after the end of CP therapy. Methods. After remission h ad been achieved for 6 months using CP and prednisolone, the CP dose w as reduced (3 months 75%, 3 months 50%) and cyclosporin was added conc omitantly (dose adjusted to whole blood levels 60-90 ng/ml). Cyclospor in therapy was continued for 1 year after the end of CP treatment. Res ults. During a mean follow-up of 24 months no patient developed a rela pse. Two patients developed a herpes tester infection. No severe bacte rial infection occurred. Conclusions. These preliminary results indica te that cyclosporin can be successfully used to sustain remission in p atients with a relapsing course of ANCA-associated vasculitis and rena l involvement.