Cytoxan for vasculitis of the lung
Pulmonary(lung) vasculitis describes a number of different disorders that involve the destruction of blood vessels. Before effective treatment was developed, the death rate of patients with a vasculitis involving the lung and other body areas was 75%, with a median duration of life of 5 months. The addition of corticosteroid therapy improved mortality at 1 yr but had no impact at 3 yr (there was significant steroid-associated side effects that killed some patients). The 5-yr mortality remained at 50%. The major breakthrough occurred whenCytoxan( cyclophosphamide) was added to corticosteroids, and this lowered the 5-yr mortality to 12%.
EUVAS study, Non-Renal Alternative With Methotrexate (NORAM) trial compared methotrexate with cyclophosphamide for the induction of remission in early disease. There weree similar rates of induction of remission at 6 months; however, the time toobtaining remission was longer in the methotrexate arm (5.2 months vs 3.2 months), and the relapse rate was statistically higher in the methotrexate arm (74% vs 42%). On the other hand, the methotrexate was better tolerated than the cyclophosphamide. Hence, cycophosphamide with steroids is first line and methotrexate, in combination with corticosteroids, is now considered an alternative first-line regimen for the treatment of early, generalized disease.
For professional version see here