Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated Vasculitis

Field: Medicine (Health Sciences)

Letters5 January 2010Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated VasculitisLee A. Hebert, MD and Brad H. Rovin, MDLee A. Hebert, MDFrom Ohio State University Medical Center, Columbus, OH 43210.Search for more papers by this author and Brad H. Rovin, MDFrom Ohio State University Medical Center, Columbus, OH 43210.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-1-201001050-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:de Groot and colleagues (1) provide a balanced discussion of the strengths and weaknesses of their randomized trial. Unfortunately, that balance was lost in the abstract's Conclusion section, which, if taken verbatim, clearly favors pulse (intravenous) cyclophosphamide over daily oral cyclophosphamide. The back story, however, is far more complex and provides substantial support for the daily oral regimen.First, recovery of kidney function may have been better with daily oral therapy. The graph showing trends in estimated glomerular filtration rate (eGFR) censored the eGFR values after onset of end-stage renal disease (ESRD). This inflated the eGFR in ...References1. de Groot K, Harper L, Jayne DR, Flores Suarez LF, Gregorini G, Gross WL, et al; EUVAS (European Vasculitis Study Group). Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med. 2009;150:670-80. [PMID: 19451574] LinkGoogle Scholar2. Agarwal A, Haddad N, Hebert LA. Progression of kidney disease: diagnosis and management.. In: Molony D, Craig J, eds. Evidence-Based Nephrology. Hoboken, NJ: J Wiley; 2008:311-22. Google Scholar3. Birmingham DJ, Rovin BH, Shidham G, Nagaraja HN, Zou X, Bissell M, et al. Spot urine protein/creatinine ratios are unreliable estimates of 24 h proteinuria in most systemic lupus erythematosus nephritis flares. Kidney Int. 2007;72:865-70. [PMID: 17653137] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Ohio State University Medical Center, Columbus, OH 43210.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic Antibody—Associated Vasculitis Kirsten de Groot , Lorraine Harper , David R.W. Jayne , Luis Felipe Flores Suarez , Gina Gregorini , Wolfgang L. Gross , Rashid Luqmani , Charles D. Pusey , Niels Rasmussen , Renato A. Sinico , Vladimir Tesar , Philippe Vanhille , Kerstin Westman , Caroline O.S. Savage , and Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated Vasculitis Stuart M. Levine Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated Vasculitis Lorraine Harper , Kirsten de Groot , and Caroline O. Savage Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated Vasculitis Prasanta Padhan Metrics 5 January 2010Volume 152, Issue 1Page: 64KeywordsCyclophosphamideHeart rateKidneysProteinsProteinuriaRenal failureUrineVasculitis ePublished: 5 January 2010 Issue Published: 5 January 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...