Azathioprine vs methotrexate in eosinophilic granulomatosis with polyangiitis: a monocentric retrospective study.

Autor:	Milanesi A; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.; Division of Rheumatology, IRCCS San Matteo of Pavia, Pavia, Italy.; PhD in Experimental Medicine, University of Pavia, Pavia, Italy., Delvino P; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.; Division of Rheumatology, IRCCS San Matteo of Pavia, Pavia, Italy.; PhD in Experimental Medicine, University of Pavia, Pavia, Italy., Quaglini S; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy., Montecucco C; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.; Division of Rheumatology, IRCCS San Matteo of Pavia, Pavia, Italy., Monti S; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.; Division of Rheumatology, IRCCS San Matteo of Pavia, Pavia, Italy.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Apr 02; Vol. 63 (4), pp. 945-952.
DOI:	10.1093/rheumatology/kead302
Abstrakt:	Objectives: To analyse the effectiveness, safety and steroid-sparing effect of AZA and MTX as induction of remission and maintenance treatment in eosinophilic granulomatosis with polyangiitis. Methods: We retrospectively collected data from 57 patients divided into four groups according to treatment: MTX/AZA as first-line agents (MTX1/AZA1) in non-severe disease or as second-line maintenance therapy (MTX2/AZA2) in severe disease previously treated with CYC/rituximab. During the first 5 years of treatment with AZA/MTX we compared the groups according to: remission rate [defined as R1: BVAS = 0; R2: BVAS = 0 with prednisone ≤5 mg/day; R3 (MIRRA definition): BVAS = 0 with prednisone ≤3.75 mg/day], persistence on therapy, cumulative glucocorticoid (GC) dose, relapse and adverse events (AEs). Results: There were no significant differences in remission rates (R1) in each group (63% in MTX1 vs 75% in AZA1, P = 0.53; 91% in MTX2 vs 71% in AZA2, P = 0.23). MTX1 allowed R2 more frequently in the first 6 months compared with AZA1 (54% vs 12%, P = 0.04); no patients receiving AZA1 achieved R3 up to the first 18 months (vs 35% in MTX1, P = 0.07). The cumulative GC dose was lower for MTX2 vs AZA2 (6 g vs 10.7 g at 5 years, P = 0.03). MTX caused more AEs compared with AZA (66% vs 30%, P = 0.004), without affecting the suspension rate. No differences emerged in time-to-first relapse, although fewer patients treated with AZA2 had asthma/ENT relapses (23% vs 64%, P = 0.04). Conclusion: A significant proportion of patients achieved remission with both MTX and AZA. MTX1 had an earlier remission on a lower GC dose but MTX2 had a better steroid-sparing effect. (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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