US researchers find new therapy for vasculitis
Researchers in the United States have reported the development of a new treatment for vasculitis – a rate disorder affecting blood vessels. The disease refers to a group of disorders characterized by inflammatory destruction of blood vessels that affects both the arteries and veins.
The new treatment provides the same benefits as the current therapy that has been prevalent for more than 40 years but required less frequent treatments. The disease is primarily a result of leukocyte migration and the resultant damage on the blood vessels.
A six-month study, led by John Stone, M.D., M.P.H., of Massachusetts General Hospital, Boston, and Ulrich Specks, M.D., of the Mayo Clinic, Rochester, Minnesota, suggests that patients who suffer from relapses also respond better to the new treatment.
Vasculitis is an auto-immune disease, where body's defense cells start attacking the normal cells. Patients with a devastating form of vasculitis make antibodies that attack immune cells called neutrophils, causing inflammation in small-to medium-sized blood vessels. This leads to organ damage, particularly in the airways, lungs and kidneys.
Microscopic polyangitis and Wegener's granulomatosis are the two main forms of this type of autoimmune vasculitis, a disease that is known to affect nearly 6,000 people in a year in the United States. Physicians treat it using a combination of cyclophosphamide plus steroids, followed by long-term daily azathioprine (AZA) plus steroids for up to six months.
A majority of patients suffering from vasculitis used to die within two years of diagnosis before this long duration, multi-drug treatment was introduced in the early 1970s.
The new alternative therapy uses a currently available anticancer drug Rituximab, which is used in the treatment of B-cell lymphomas, chronic lymphocytic leukaemia and rheumatoid arthritis. "First, we wanted to induce disease remission and reduce or eliminate maintenance steroid use. Second, we wanted to find a less toxic therapy that also will prolong remission," says Dr. Stone.
In their study involving 197 participants, the researchers administered intravenous Rituximab therapy once a week for a month and added steroids for one group of patients. The other group received daily cyclophosphamide therapy for three to six months with administration of steroids, followed by the daily AZA.
Analyses of the results after six months of therapy showed that 64 percent of the participants in the Rituximab group and 53 per cent in the cyclophosphamide group had no disease activity and were able to completely discontinue the use of steroids, says the study report published online in the New England Journal of Medicine.