1. Raj Kiran Medapalli, MD, MPH. Nephrology Fellow May 19 th , 2009 Mount Sinai School of Medicine Division of Nephrology Journal Club

2. Pulse vs. Daily Oral Cyclophosphamide for Induction of Remission in ANCA-Associated Vasculitis The “CYCLOPS” Study European Vasculitis Study Group (EUVAS) Annals of Internal Medicine 19 May 2009 Journal Club by Raj Kiran Medapalli, MD

4. Source: Brenner & Rector's The Kidney, 8 th Edition.

6. Source: Falk RJ & Jennette JC. JASN. 1997. C-ANCA, anti-Proteinase 3 P-ANCA, anti-Myeloperoxidase Anti-neutrophil cytoplasmic antibodies

7. Source: Xiao H, et al. Am J of Path. Jan 2007.

18. Pulse vs. Daily Oral Cyclophosphamide for Induction of Remission in ANCA-Associated Vasculitis The “CYCLOPS” Study European Vasculitis Study Group (EUVAS) Annals of Internal Medicine 19 May 2009

20. Intervention Pulse (IV or PO) Cytoxan Daily PO Cytoxan Induction 15 mg/kg IV Q2wkly x 3 doses 2 mg/kg/d, until remission 15 mg/kg IV or 5 mg/kg PO on 3 consecutive days, q3wkly, until remission (physician discretion) Initial maintenance Continue above for 3 months 1.5 mg/kg/d for 3 months Max dose 1.2 g per pulse 200 mg/d Age 60-70 Reduce by 2.5 mg/kg per pulse Reduce by 25% Age >70 Reduce by 5 mg/kg per pulse Reduce by 50% Creat 3.4 to 5.7 Reduce by 2.5 mg/kg per pulse - CBC checks Day 0,10,14 Q wkly x 1 month, Q2wkly x 1 month, then monthly 3 - 4 x 10 9 /L - Withhold dose and resume at a dose reduced by 25 mg/d when WBC > 4 x 10 9 /L 2 - 3 x 10 9 /L Reduce dose by 20% 1 - 2 x 10 9 /L Reduce dose by 40%

43. EUVAS Guidelines

44. Thank You.