Christian Pagnoux, M.D., M .P.H., Alfred Mahr, M.D., Ph.D., Mohamed A. Hamidou, M.D., Jean-Jacques Boffa, M.D., Marc Ruivard, M.D., Jean-Pierre Ducroix, M.D., Xavier Kyndt, M.D.D., Thomas Papo, M.D., Marc Lambert, M.D., Ph.D.D., Mehdi Khellaf, M.D., Dominique Merrien, M.D.D., Ph.D.D., Pascal Cohen, M.D., Luc Mouthon, M.D., Ph.D.D.D.1,2 Moreover, even after induction with daily oral or pulse intravenous cyclophosphamide therapy, relapse rates remain as high as 15 percent at 12 weeks3 and reach 38 percent at 30 months. This strategy uses cyclophosphamide to induce remission, accompanied by a less toxic immunosuppressant. A randomized trial where 30 patients with several systemic vasculitides were designated to get remission maintenance therapy with azathioprine or oral cyclophosphamide showed equivalent relapse rates with both agents and a nonsignificant reduction in rates of adverse events with oral cyclophosphamide.6 Although the results of uncontrolled research suggested that methotrexate might provide effective maintenance therapy for sufferers with Wegener’s granulomatosis, with a toxicity profile that may be as effective as or even better than that of azathioprine,7-9 it remains unclear whether one of these two agents could be safer or even more effective compared to the other.