| Treatment of polyarteritis nodosa related to hepatitis B virus with short term steroid therapy associated with antiviral agents and plasma exchanges. A prospective trial in 33 patients. | |
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MedLine Citation:
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PMID: 8097249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To test the effectiveness and tolerance of antiviral agents associated with short term immunosuppression in the treatment of polyarteritis nodosa (PAN) related to hepatitis B virus (HBV). METHODS: We conducted a prospective, nonblinded, multicenter trial in which patients with multisystemic PAN related to HBV were included. Every patient initially underwent a short term (2 weeks) treatment with prednisone and then received vidarabine (Vira A) and plasma exchanges. The end point of the study was control of the disease (recovery or remission) or death. RESULTS: Thirty-three patients were included. Every patient had histopathologic or arteriographic evidence of vasculitis and was infected with actively replicating HBV. Disease activity during the first 6 months was controlled in 26 patients (78.8%). Among the 25 patients still alive at the end of the study, 24 (72.7%) had completely recovered with no clinical or laboratory evidence of systemic vasculitis after at least 18 months without treatment. Eight patients died during the study period; 3 of treatment failure, usually early in the course of the disease. One patient died of fulminant hepatitis 3 months after the entry in the study at time of seroconversion. The survival curve showed that at 7 years, 76% of the patients were alive. HBeAg/anti-HBeAb seroconversion was observed in 12 patients (36.3%) after one Vira A cycle. When a 2nd cycle of Vira A or alpha interferon was prescribed, HBeAg/anti-HBeAg seroconversion occurred in 15 patients (45.4%). Two other patients who underwent a 2nd cycle of Vira A administration, had lost HBeAg and no longer expressed serological evidence of replication as assessed by HBV DNA spot hybridization. At the end of the study, 17 (51.5%) no longer expressed serological evidence of HBV replication. This treatment was effective and only minor side effects were noted. CONCLUSIONS: We conclude that this new therapeutic approach to PAN related to HBV effectively controlled systemic vasculitis and was associated with a higher number of recoveries from chronic HBV infections. The development of new antiviral agents, such as interferon alpha 2b, allows us to hope that antiviral therapy will have a role to play as a first line treatment regimen of virus induced vasculitis. |
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Authors:
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L Guillevin; F Lhote; A Leon; F Fauvelle; L Vivitski; C Trepo |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of rheumatology Volume: 20 ISSN: 0315-162X ISO Abbreviation: J. Rheumatol. Publication Date: 1993 Feb |
Date Detail:
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Created Date: 1993-05-18 Completed Date: 1993-05-18 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 7501984 Medline TA: J Rheumatol Country: CANADA |
Other Details:
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Languages: eng Pagination: 289-98 Citation Subset: IM |
Affiliation:
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Department of Internal Medicine, Blood Bank and Pharmacy, Bobigny, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cause of Death Female Follow-Up Studies Hepatitis B / complications*, epidemiology, therapy Hepatitis B virus* / drug effects Humans Liver / pathology Liver Function Tests Male Middle Aged Plasma Exchange* / adverse effects Polyarteritis Nodosa / drug therapy, epidemiology, etiology* Prednisolone / adverse effects, therapeutic use* Prospective Studies Treatment Outcome Vidarabine / adverse effects, therapeutic use* |
| Chemical | |
Reg. No./Substance:
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50-24-8/Prednisolone; 5536-17-4/Vidarabine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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