Israel H L
Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Arch Intern Med. 1988 Oct;148(10):2293-5.
Cyclophosphamide has proved to be the most effective therapy for Wegener's granulomatosis, but mortality remains high at many medical centers, and the necessity for giving this toxic agent for many years to prevent relapses remains a major problem. Successful treatment of this disease with sulfamethoxazole-trimethoprim has been reported by DeRemee et al, and experience in a series of ten patients at Thomas Jefferson University Hospital, Philadelphia, confirms its effectiveness. Nine patients are in remission, and the condition of one patient improved. Relapses occurred in four patients after intervals of remission ranging from four to 30 months, but responded to increased doses of trimethoprim in two patients, while two patients required resumption of therapy with cytotoxic agents. Although the effects of sulfamethoxazole-trimethoprim are suppressive rather than curative, its use represents a major advance in treatment of Wegener's granulomatosis, permitting successful treatment of many patients without high toxic doses of cyclophosphamide and prednisone.
环磷酰胺已被证明是治疗韦格纳肉芽肿最有效的疗法，但在许多医疗中心死亡率仍然很高，而且为预防复发而多年使用这种毒性药物的必要性仍然是一个主要问题。DeRemee等人报告了用磺胺甲恶唑-甲氧苄啶成功治疗这种疾病的情况，费城托马斯杰斐逊大学医院对一系列10名患者的治疗经验证实了其有效性。9名患者病情缓解，1名患者病情改善。4名患者在缓解期4至30个月后复发，但其中2名患者对增加剂量的甲氧苄啶有反应，而另外2名患者需要恢复使用细胞毒性药物治疗。虽然磺胺甲恶唑-甲氧苄啶的作用是抑制性而非治愈性的，但它的使用代表了韦格纳肉芽肿治疗的一项重大进展，使得许多患者无需使用高毒性剂量的环磷酰胺和泼尼松就能获得成功治疗。
