Abatacept: The presence of activated T lymphocytes within WG lesions has raised the question as to whether interference with costimulation could modulate disease. The Vasculitis Clinical Research Consortium is currently conducting a pilot study investigating abatacept in mild relapsing WG. There has been no experience with abatacept in WG to date, and this should not be used in clinical practice.
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Explore This IssueOctober 2008
Monitoring and Toxicity Prevention
Monitoring for disease activity and medication toxicity is among the most important aspects of care in a patient with WG. The type and frequency of monitoring will depend largely on the medications the patient receives (see Table 1, p. 19). Monitoring blood counts to prevent neutropenia and maintain the absolute neutrophil count above 1500/mm3 lessens the risk of infection-related morbidity and mortality that can occur from bacterial and opportunistic pathogens. For patients who do not have blood in their urine, self–urine dipstick testing can help detect new hematuria as an early indicator of renal disease.
For patients with pulmonary disease, perform chest imaging one month after the initiation of induction treatment to confirm improvement, at the time of transition to maintenance therapy, and every three to six months thereafter. For patients who do not have pulmonary disease, perform imaging every six to 12 months or for new symptoms.
There is much we have left to learn about WG; understanding disease pathophysiology plays a critical role in future innovations. Gaining a greater knowledge of disease mechanisms will allow those in the field to make informed decisions when planning novel clinical trials.
In 2008, there is much that physicians can offer WG patients—this includes not only our current treatment and monitoring strategies but also hope for the many advances to come.
Dr. Langford is director of the Center for Vasculitis Care and Research and associate professor of medicine at Cleveland Clinic in Cleveland, Ohio.
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