Advances in Therapy for ANCA-Associated Vasculitis
Current Rheumatology Reports, 08/20/2012
Geetha D et al. – For patients with life–threatening disease, plasma exchange may be an effective adjuvant therapy.
- The anti-neutrophil cytoplasmic antibody-associated vasculitides include granulomatosis with polyangiitis (Wegener’s granulomatosis) and microscopic polyangiitis.
- The introduction of therapy with cytotoxic agents such as cyclophosphamide transformed these diseases from fatal diagnoses to chronic conditions characterized by cycles of relapse and remission.
- Modern treatment strategies have focused on minimizing cyclophosphamide exposure or eliminating its use altogether.
- Two randomized clinical trials have shown that rituximab is not inferior to cyclophosphamide for induction of remission in patients with severe granulomatosis with polyangiitis (Wegener’s) or microscopic polyangiitis.
- For patients with non-life threatening disease, methotrexate may be used to induce and maintain remission, although some patients may have a higher long-term risk of relapse as a result.