【持续性肾脏替代治疗CRRT英文ppt课件】Tuesday Clinical Case Conference.pptVIP

Pulse versus daily oral cyclophosphamide - De Groot et al published a metaanalysis of the existing trials 11 non-randomized studies N = 202 patients She concluded that there was no difference in hard outcomes, death, renal failure, or remission. There were more relapses in the pulse group, but fewer infections and a lower dose of cyclophosphamide, but it is important to add here, that these trials tended not to use remission management therapy with an alternative immunosuppressive. Meta-analysis of 3 randomized-controlled studies comprising 143 patients (101 with WG + 42 MPA) Pulse Cyc compared with po Cyc was significantly less likely to fail to induce remission (OR 0.29; 95% CI 0.12-0.73); with significantly lower risk of infection (OR 0.45; 95% CI 0.23-0.89) or leucopenia (OR 0.36; 95%CI 0.17-0.76 Relapses occurred more often under pulse Cyc treatment, although not statistically significant (OR 1.79; 95% CI 0.85-3.75) * Pulse IV Total of 160 patients with renal vasculitis (Crt 500 umol / 5.7 crt) at diagnosis Randomized and followed for 18 months pulse cyclophosphamide (10 doses given in first 6 months) daily oral regimen (initially 2 mg/kg then tapred to 1.5 mg/kg by 6 months) Switched to maintenace with Aza after remission * in the daily oral group and in the pulse group, there is no difference in time to remission. * When you look at time to flare, at least up to an 18 months time point, there is no difference in time to flare No difference in efficacy between pulse IV and daily oral Safety in unknown, though IV received significantly less (cumulative CYC dose was ~ ? dose of) PO * * The question was how much cyclophosphamide. Whether exposure to CYC in pts with generalized vasculitis could be reduced by substitution of AZA at remission. Patients Vasculitis / crt 5.7 At least 3 mos of CYC, then with remission switch to AZA or CYC, fu for 18 mos n = 144 AZA = 71 CYC = 73 ANCA (+), mostly WG GFR 50 cc/min After induction of remission, rando