Treatment of Advanced Wegener's Granulomatosis with Azathioprine and Duazomycin a

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Abstract
Azathioprine (Imuran) was used in combination with duazomycin A, a glutamine antagonist, for treatment of two patients with advanced Wegener's granulomatosis with renal involvement. Prolonged survival, remission of systemic signs and symptoms, roentogenologic improvement of pulmonary lesions, reduction in proteinuria and arrest of progression of renal insufficiency were observed, despite persistent histologic lesions in repeat kidney biopsies. Immunologic tests for humoral antibodies and delayed-type hypersensitivity indicated effective suppression of these immune responses to a new antigen but no alteration in pre-existing immunity. These results and absence of toxic complications encourage further studies of this rational combination of chemotherapeutic agents to assess the extent of their effectiveness in immunologic disorders.