Microscopic polyangiitis medical therapy

Microscopic polyangiitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Microscopic polyangiitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Radiation therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Microscopic polyangiitis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Microscopic polyangiitis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Microscopic polyangiitis medical therapy
CDC on Microscopic polyangiitis medical therapy
Microscopic polyangiitis medical therapy in the news
Blogs on Microscopic polyangiitis medical therapy
Directions to Hospitals Treating Type chapter name here
Risk calculators and risk factors for 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

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

• Pharmacologic medical therapies for Microscopic polyangiitis include glucocorticoids and immunosuppressant.

Corticosteroids:

• In more aggressive forms of the disease prednisone is interchanged with methylprednisolone.
• 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.
• 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

• 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.