Lower-Dose Therapy Is Associated with Fewer Serious Adverse Events in Elders with Systemic Necrotizing Vasculitis

Treating patients with systemic necrotizing vasculitides (SNV; i.e., polyarteritis nodosa, granulomatosis with polyangiitis [GPA], microscopic polyangiitis, and eosinophilic GPA) often is complicated by serious adverse events, most of them infection-related. Although lower doses of cyclophosphamide (CYC) sometimes are recommended in older patients (age, ≥65) and those with renal insufficiency, evidence on outcomes associated with this approach is lacking. In this nonblinded study from France, 104 patients with newly diagnosed SNV were randomized to receive steroids and intravenous CYC in standard doses (conventional group) or lower doses (experimental group). Following CYC therapy, both groups received maintenance therapy with azathioprine,…