Blog entry by Meguid El Nahas
Questions and answers put to Prof Glassock following his talk on the Management of Vasculitis:
Prof Salah Naga: Is there a role for CNIs in the management of ANCA associated systemic vasculitis?
Prof Glassock: CNIs do not seem to be very effective in the management of AASV. They certainly dont feature in the recognised effective therapeutic approaches.
Prof Sabry Gohar: Is there a role for Infliximab in AASV?
Prof Glassock: No role and many reports of significant side effects including a high rate of infectious complications.
Prof Adel Afifi: IN the face of an increase in sCr, when would you rebiopsy?
Prof Glassock: Rebiopsying should be considered in the face of clinical, biochemical (CRP) or immunological (Autoantibodies) signs of disease activity.
Prof Afifi: How do you treat relapses?
Prof Glassock: I treat relapses of AASV with rituximab to avoid the toxicity of repeat courses of cyclophosphamide.
Prof Essam Nooreldin: How do you prevent hemorrhagic cystitis?
Prof Glassock: In more than 30 years of practice, I did not see a single case of hemorrhagic cystitis.
I tend to prescribe the cyclophosphamide to be taken at 9am
along with 4 glasses of water and I encourage th epatient to drink more water at bedtime (another 4 glasses).
Prof El Nahas: Do you think that Plasma exchange is beneficial outdside the indication for lung hemmorhage?
Prof Glassock: Whilst the MEPEX study showed some benfit at 12 months, follow up study over more than 3 years failed to show any advantage of plasma exchange of ESRD or death and was associated with increased toxicity/side effects (Walsh and Jayne, Personal Communication).