Microscopic polyangiitis medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Overview
Microscopic polyangiitis responds well to treatment with glucocorticoids such as prednisone together with an immunosuppressant such as cyclophosphamide. The combination of these 2 drugs decreases the remission of Microscopic polyangiitis by about 90%.
Medical Therapy
Medical Therapy
- Pharmacologic medical therapies for Microscopic polyangiitis include glucocorticoids and immunosuppressant.[1][2]
Corticosteroids:
- In more aggressive forms of the disease prednisone is interchanged with methylprednisolone.[3][4]
- Both mild and severe forms of the disease are administered together with cyclophosphamide which is given in intravenous pulses every 2 weeks.
- After the first 3 doses, cyclophosphamide is administered every 3 weeks.
- Cyclophosphamide can also be given orally at a dose of 2 mg/kg/day, however, more side effects are seen with the oral dose, such as neutropenia.
- The dose of prednisone that is given is 1 mg/kg/day for less aggressive forms of the disease.
- If Microscopic polyangiitis is severe, plasmapheresis may also be given in conjunction with an immunosuppressant and glucocorticoid.
- Plasmapheresis has been shown to have benefit in patients with pulmonary and renal involvement.
- Preferred regimen (1): Methylprednisolone 1g/kg 3 times a day.
- Preferred regimen (2): Cyclophosphamide 15 mg/kg.
Rituximab
- Induction therapy using rituximab and glucocorticoids in a recent study conducted by RITUXVAS compared rituximab and cyclophosphamide.[5][6]
- The trial showed no superiority, in that both medications were effective at inducing remission. However, the safety and the long term use of rituximab needs to be further addressed.
Maintenance Therapy
Maintenance Therapy
- The maintenance therapy for Microscopic polyangiitis is with azathioprine, which is less toxic to that of cyclophosphamide. Azathioprine is administered for 18 months.
- Preferred regimen (1):Azathioprine 1 to 2 mg/kg/day.
- Other medications that may be used as maintenance are:
- Preferred regimen (1): Mycophenolate mofetil up to 1g twice a day.
- Preferred regimen (2): Methotrexate: 0.3 to 25 mg/kg/week.
References
References
- ↑ Greco A, De Virgilio A, Rizzo MI, Gallo A, Magliulo G, Fusconi M; et al. (2015). “Microscopic polyangiitis: Advances in diagnostic and therapeutic approaches”. Autoimmun Rev. 14 (9): 837–44. doi:10.1016/j.autrev.2015.05.005. PMID 25992801.
- ↑ Walsh M, Casian A, Flossmann O, Westman K, Höglund P, Pusey C, Jayne DR (August 2013). “Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear”. Kidney Int. 84 (2): 397–402. doi:10.1038/ki.2013.131. PMID 23615499.
- ↑ Walsh M, Merkel PA, Mahr A, Jayne D (August 2010). “Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis”. Arthritis Care Res (Hoboken). 62 (8): 1166–73. doi:10.1002/acr.20176. PMC 2946200. PMID 20235186.
- ↑ Hellmich B (June 2015). “[Treatment strategies for ANCA-associated vasculitides]”. Z Rheumatol (in German). 74 (5): 388–97. doi:10.1007/s00393-014-1532-7. PMID 26031284.
- ↑ Jayne D (January 2008). “Challenges in the management of microscopic polyangiitis: past, present and future”. Curr Opin Rheumatol. 20 (1): 3–9. doi:10.1097/BOR.0b013e3282f370d1. PMID 18281850.
- ↑ McGregor JG, Hogan SL, Kotzen ES, Poulton CJ, Hu Y, Negrete-Lopez R, Kidd JM, Katsanos SL, Bunch DO, Nachman PH, Falk RJ (April 2015). “Rituximab as an immunosuppressant in antineutrophil cytoplasmic antibody-associated vasculitis”. Nephrol. Dial. Transplant. 30 Suppl 1: i123–31. doi:10.1093/ndt/gfv076. PMC 4447867. PMID 25805743.
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