Using Cyclophosphamide and Methotrexate for Wegener's
In cases of Wegener's granulomatosis, azathioprine (also called Imuran®) is used primarily to maintain remission in people who have initially been treated and gone into remission with cyclophosphamide.
Azathioprine is taken once a day by mouth. Similar to methotrexate, people with Wegener's granulomatosis usually take it for one to two years, after which the dosage is lowered until it is stopped.
The side effects of azathioprine can include:
- Lowering of the blood counts
- An allergic-type reaction (this is rare).
In people who receive azathioprine to prevent rejection of a transplanted organ, there has been a suggestion of an increased risk of blood cancers (leukemia and lymphoma), but it is not clear whether this risk exists in other situations. People with poor kidney function or liver disease can take azathioprine.
Other Medications Used to Treat Wegener's
During treatment for Wegener's granulomatosis, doctors often give their patients other medicines to prevent medicine-related side effects. These include:
- Trimethoprim/sulfamethoxazole (also called Bactrim® or Septra®) is given three times a week to prevent Pneumocystis carinii infection (a lung infection)
- A medicine regimen is often given to prevent prednisone-related bone loss (osteoporosis)
- Folic acid or folinic acid (also called leucovorin) are often given to people taking methotrexate.
Prognosis for Wegener's
With the appropriate treatment, the outlook is good for people with Wegener's granulomatosis. In a study of 158 patients who were treated with prednisone and cyclophosphamide at the National Institutes of Health (NIH), 91 percent of them markedly improved. After 6 months to 24 years of follow-up, 80 percent of the patients survived.
Approximately half of people with Wegener's granulomatosis may experience a return of their disease. This occurs most frequently within two years of stopping medicine, but it can occur at any point, either during treatment or after stopping treatment. Therefore, it is extremely important that people with Wegener's granulomatosis continue to see their doctors regularly, both while they are on these medicines and after the medicines have been stopped.