Lee A. Hebert, MD; Brad H. Rovin, MD
Potential Conflicts of Interest: None disclosed.
Hebert L., Rovin B.; Pulse Versus Daily Oral Cyclophosphamide in ANCA-Associated Vasculitis. Ann Intern Med. 2010;152:64. doi: 10.7326/0003-4819-152-1-201001050-00020
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Published: Ann Intern Med. 2010;152(1):64.
TO THE EDITOR:
de Groot and colleagues (1) provide a balanced discussion of the strengths and weaknesses of their randomized trial. Unfortunately, that balance was lost in the abstract's Conclusion section, which, if taken verbatim, clearly favors pulse (intravenous) cyclophosphamide over daily oral cyclophosphamide. The back story, however, is far more complex and provides substantial support for the daily oral regimen.
First, recovery of kidney function may have been better with daily oral therapy. The graph showing trends in estimated glomerular filtration rate (eGFR) censored the eGFR values after onset of end-stage renal disease (ESRD). This inflated the eGFR in the pulse group, because it had 5 ESRD events versus only 1 ESRD event in the daily oral group. We suggest the eGFR analysis be repeated after assigning an eGFR of 5 mL/min per 1.73 m2 to each patient with ESRD.
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