What is the treatment for Wegener's granulomatosis?
The goal is to make the diagnosis early and begin treatment before there is kidney failure. The primary treatment is with the medicines cyclophosphamide (an anti-cancer drug) and prednisone (a steroid). The disease can be stopped in up to 75% of patients treated with these medicines. However, up to half of the patients who are successfully treated will eventually
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develop the disease again. Also, there is an increased risk of developing cancer in those patients treated with cyclophosphamide. Other drugs such as Methotrexate (an anti-cancer drug) and trimethoprim-sulfamethoxazole (an antibiotic) can be used to prevent repeat flare-ups of the disease.
Wegener's granulomatosis is often treated with a combination of corticosteroids and immunosuppressive drugs. The corticosteroids control the inflammation, and the immunosuppressives appear to stop the growth of granulomas. The immunosuppressive drugs most commonly used to treat Wegener's granulomatosis are cyclophosphamide and methotrexate.
When therapy is started, corticosteroids are given in high doses. Usually, the dose can be lowered after about two to four months and gradually tapered until only the immunosuppressive drug is needed. The combination antibiotic trimethoprim-sulfamethoxazole is ineffective for life-threatening disease but has been beneficial in helping to keep patients in remission. Both corticosteroids and immunosuppressive drugs can produce serious side effects. When a person takes high doses of corticosteroids for several months, easy bruising, osteoporosis (thinning of the bones which can lead to fractures), cataracts, weight gain, and susceptibility to infections can result. Immunosuppressive drugs can cause anemia and other blood abnormalities, susceptibility to infections, nausea and vomiting, skin rash, sterility, and kidney and bladder problems. If a patient is taking cyclophosphamide, it is important to drink a lot of fluids (at least 3 liters or quarts of water a day) to avoid bladder infection. |
