Azathioprine vs methotrexate in eosinophilic granulomatosis with polyangiitis: a monocentric retrospective study.

Abstract

OBJECTIVES:

To analyse effectiveness, safety, and steroid-sparing effect of AZA and MTX as induction of remission and maintenance treatment in eosinophilic granulomatosis with polyangiitis.

METHODS:

We retrospectively collected data from 57 patients divided in 4 groups according to treatment: MTX/AZA as first-line agents (MTX1/AZA1) in non-severe disease, or as second-line maintenance therapy (MTX2/AZA2) in severe disease previously treated with CYC/rituximab. During the first five years of treatment with AZA/MTX we compared the groups according to: remission rate (defined as R1: BVAS = 0, R2: BVAS = 0 with prednisone ≤5mg/day, R3-MIRRA definition: BVAS = 0 with prednisone ≤ 3.75 mg/day), persistence on therapy, cumulative glucocorticoid (GC) dose, relapse, and adverse events (AE).

RESULTS:

There were no significant differences in remission rates (R1) in each group (63% in MTX1 vs 75% in AZA1, p= 0.53; 91% in MTX2 vs 71% in AZA2, p= 0.23). MTX1 allowed R2 more frequently in the first 6 months compared with AZA1 (54% vs 12%, p= 0.04); no patients receiving AZA1 achieved R3 up to the first 18 months (vs 35% in MTX1, p= 0.07). Cumulative GC dose was lower for MTX2 vs AZA2 (6 g vs 10.7 g at 5 years, p= 0.03). MTX caused more AE compared with AZA (66% vs 30%, p= 0.004), without affecting the suspension rate. No differences emerged in time-to-first relapse, although fewer patients treated with AZA2 had asthma/ENT relapses (23% vs 64%, p= 0.04).

CONCLUSION:

A significant proportion of patients achieved remission with both MTX and AZA. MTX1 had an earlier remission on lower GC dose, MTX2 had better steroid-sparing effect.

• Authors: Alessandra Milanesi, Paolo Delvino, Silvana Quaglini, Carlomaurizio Montecucco, Sara Monti
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) (Jun 16 2023) ISSN: 1462-0332 [Electronic] England
• PMID: 37326880 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].