The efficacy of an individual treatment schedule in patients with vasculitis.

The aim of the study was to determine the efficacy of an individual treatment schedule in patients with systemic vasculitis. Clinical, laboratory, morphological and immunological data before and after treatment were followed in 18 patients: eight with microscopic polyangiitis, two with Wegener's granulomatosis, four with leukocytoclastic vasculitis and four with necrotizing/crescentic glomerulonephritis. Patients received individual treatment for 14.89+/-13.9 months according to the disease activity. Methylprednisolone pulse therapy (PT) was given to 16 patients, mean 1.94+/-0.4 PT/patient, followed by a slowly tapered oral dose (0.7-1 mg/kg). Cyclophosphamide PT was received by 15 patients, mean 3.13+/-0.9/patient in doses of 8-10 mg/kg, followed by an oral dose of 1 mg/kg for 9.17+/-1.9 months. Four additional patients were treated with cyclosporin A for 3 months. Eleven patients received heparin for 30 days. Plasmapheresis was provided in seven patients. Two patients were treated with azathioprine and one patient with mycophenolate mofetil. There were no significant changes in serum creatinine and creatinine clearance during the observation period. Proteinuria and haematuria improved after treatment. Kidney function improved or became stable in 66.67% of patients. No patient required haemodialysis. Haematuria was no longer observed at the end of the study in nine of 11 patients. Thirteen patients (72.22%) had clinical remission. Relapses occurred in five patients. Kidney re-biopsies showed a decrease in morphological changes in 57.2%. In conclusion, individual treatment is more flexible and controls the disease activity better.