A Case Report of Steroid‐resistant Antineutrophil Cytoplasmic Antibody‐related Vasculitis Successfully Treated by Mizoribine in a Hemodialysis Patient

• Published in: Therapeutic apheresis and dialysis 2009-02, Vol.13 (1), p.77-79
• Main Authors: Tokunaga, Masaki, Tamura, Masahito, Kabashima, Narutoshi, Serino, Ryota, Shibata, Tatsuya, Matsumoto, Mika, Miyamoto, Tetsu, Miyazaki, Mieko, Furuno, Yumi, Fujimatsu, Shinji, Muta, Toshiyuki, Takeuchi, Masaaki, Abe, Haruhiko, Okazaki, Masahiro, Otsuji, Yutaka
• Format: Article
• Language: English
• Subjects: Adult; Antibodies, Antineutrophil Cytoplasmic - immunology; Antineutrophil cytoplasmic antibody‐related vasculitis; Glucocorticoids - therapeutic use; Hemodialysis; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - pharmacokinetics; Immunosuppressive Agents - therapeutic use; Lung Diseases, Interstitial - drug therapy; Male; Mizoribine; Pharmacokinetics; Prednisolone - therapeutic use; Renal Dialysis; Renal insufficiency; Renal Insufficiency - etiology; Renal Insufficiency - therapy; Ribonucleosides - administration & dosage; Ribonucleosides - pharmacokinetics; Ribonucleosides - therapeutic use; Treatment Outcome; Vasculitis - complications; Vasculitis - drug therapy; Vasculitis - immunology
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/j.1744-9987.2009.00601.x

:  Mizoribine (MZR) has shown to be effective against antineutrophil cytoplasmic antibody (ANCA)‐related vasculitis; however, no reports have described the successful treatment of steroid‐resistant ANCA‐related vasculitis with MZR in patients with renal insufficiency requiring hemodialysis. We herein report the case of a 39‐year‐old man undergoing hemodialysis in whom MZR successfully lowered the myeloperoxidase (MPO)–ANCA titer accompanied by remission of interstitial pneumonia, together with the pharmacokinetics of MZR. The patient developed severe renal insufficiency and interstitial pneumonia, and was started on hemodialysis. Although prednisolone was administered followed by azathioprine, the MPO–ANCA level and interstitial pneumonia showed insufficient improvement. Azathioprine was replaced by MZR and the administered dose of MZR was determined by measuring serum concentrations of MZR at the start of the dialysis session; this was because we confirmed that MZR could only be removed via dialysis, and that the serum concentration of MZR was maintained until the next dialysis session. The maintenance dose was finally set at MZR 75 mg after each dialysis. Subsequently, the ANCA titer decreased and interstitial pneumonia resolved without any MZR‐related side effects. This case demonstrates that MZR is safe and effective, even in patients with steroid‐resistant ANCA‐related vasculitis undergoing hemodialysis, and can be monitored by measuring serum concentrations of MZR.