Use of methotrexate and glucocorticoids in the treatment of Wegener's granulomatosis. Long-term renal outcome in patients with glomerulonephritis.
OBJECTIVE
To determine the long-term renal outcome in patients with Wegener's granulomatosis (WG) and active glomerulonephritis who were treated with methotrexate (MTX) and glucocorticoids.


METHODS
An open-label, prospective standardized trial using weekly low-dose MTX and glucocorticoids for the treatment of WG was performed. Forty-two patients were enrolled into the study, of whom 21 had active glomerulonephritis as a disease manifestation. The mean pretreatment level of serum creatinine in the patients with glomerulonephritis was 1.4 mg/dl. The extent of renal function in these patients at the time of their last followup was subsequently examined.


RESULTS
Overall, 20 of 21 patients achieved renal remission. At 1 month and 6 months following study entry, the serum creatinine level in all patients either remained stable or improved. The 20 patients have now been followed up for a median time of 76 months (range 20-108 months). Only 2 patients have had a rise of >0.2 mg/dl in their creatinine level from the time of enrollment to the most recent followup examination. Of the remaining 18 patients, 12 have had stable renal function and 6 have had improvement in their creatinine levels by more than 0.2 mg/dl.


CONCLUSIONS
In this study, the use of MTX and prednisone as initial therapy for patients with WG-related glomerulonephritis and a normal or near-normal level of serum creatinine was not associated with a long-term decline in renal function.
Langford
C A
CA
National Institute of Allergy and Infectious Disease, NIH, Bethesda, Maryland, USA.
Talar-Williams
C
C
Sneller
M C
MC
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use*; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D003404:Creatinine; D008727:Methotrexate