Primary Systemic Vasculitis Outpatient Clinic, Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland.
Eur J Med Res. 2009 Dec 7;14 Suppl 4(Suppl 4):265-7. doi: 10.1186/2047-783x-14-s4-265.
Bacterial and viral respiratory tract infections may trigger relapses in patients with PR3-positive vasculitis. Data have suggested that treatment with co-trimoxazole may be beneficial, because this antibiotic could act by eliminating the offending microbe and thereby stopping the initiating stimulus.
Prospective, randomized, placebo-controlled study of the efficacy of co-trimoxazole given 960 mg thrice weekly for 18 months in preventing relapses in patients with Wegener's granulomatosis (WG) in remission, after treatment with cyclophosphamide and prednisolone was conducted. Relapses and infections were assessed with predefined criteria based on clinical, laboratory, serological, microbiological, and histopathological findings. Sixteen patients were assigned to receive co-trimoxazole and 15 to receive placebo.
Seventy five percent of the patients in the co-trimoxazole group remained in remission at 18 months and 55% of those in the placebo group. A proportional hazard regression analysis identified a positive PR3-ANCA test at the start of treatment, chronic nasal crusting, and Staphylococus aureus infection as risk factors for relapse. Furthermore, the analysis identified treatment with co-trimoxazole as an independent factor associated with prolonged disease-free interval.
Treatment with co-trimoxazole reduces the incidence of relapses in patients with Wegener's granulomatosis in remission.
细菌和病毒呼吸道感染可能会引发 PR3 阳性血管炎患者的复发。有数据表明，复方新诺明治疗可能有益，因为这种抗生素可以通过消除致病微生物并阻止起始刺激来发挥作用。
对接受环磷酰胺和泼尼松龙治疗缓解后的韦格纳肉芽肿（WG）患者进行了为期 18 个月的每周 3 次给予 960mg 复方新诺明的预防复发的疗效的前瞻性、随机、安慰剂对照研究。复发和感染采用基于临床、实验室、血清学、微生物学和组织病理学发现的预定义标准进行评估。16 名患者被分配接受复方新诺明治疗，15 名患者接受安慰剂治疗。
复方新诺明组 75%的患者在 18 个月时仍处于缓解期，而安慰剂组则有 55%的患者。比例风险回归分析确定治疗开始时 PR3-ANCA 检测阳性、慢性鼻结痂和金黄色葡萄球菌感染是复发的危险因素。此外，分析还确定了复方新诺明治疗是与无疾病间隔延长相关的独立因素。
复方新诺明治疗可降低缓解期韦格纳肉芽肿患者的复发率。
