Churg-Strauss syndrome medical therapy: Difference between revisions
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Either of these treatments can be given after a few days of oral cyclophosphamide; to 2 to 3 weeks after pulse administrative doses. The time frame at which these medications are to be administered to is currently unknown; however, 18-24 months of remission of these 2 agents have been noted.<ref name="pmid259711542">{{cite journal| author=Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V et al.| title=Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. | journal=Eur J Intern Med | year= 2015 | volume= 26 | issue= 7 | pages= 545-53 | pmid=25971154 | doi=10.1016/j.ejim.2015.04.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25971154 }}</ref> According to Sanders et al, 2005 at 18 months the relapse rate of azathioprine is 13.3% and at 5 years the relapse rate is 62.3% respectively.<ref>{{cite journal |author=Bosch X, Guilabert A, Espinosa G, Mirapeix E |title=Treatment of antineutrophil cytoplasmic antibody associated vasculitis: a systematic review |journal=JAMA |volume=298 |issue=6 |pages=655–69 |year=2007 |pmid=17684188 |doi=10.1001/jama.298.6.655}}</ref> | Either of these treatments can be given after a few days of oral cyclophosphamide; to 2 to 3 weeks after pulse administrative doses. The time frame at which these medications are to be administered to is currently unknown; however, 18-24 months of remission of these 2 agents have been noted.<ref name="pmid259711542">{{cite journal| author=Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V et al.| title=Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. | journal=Eur J Intern Med | year= 2015 | volume= 26 | issue= 7 | pages= 545-53 | pmid=25971154 | doi=10.1016/j.ejim.2015.04.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25971154 }}</ref> According to Sanders et al, 2005 at 18 months the relapse rate of azathioprine is 13.3% and at 5 years the relapse rate is 62.3% respectively.<ref>{{cite journal |author=Bosch X, Guilabert A, Espinosa G, Mirapeix E |title=Treatment of antineutrophil cytoplasmic antibody associated vasculitis: a systematic review |journal=JAMA |volume=298 |issue=6 |pages=655–69 |year=2007 |pmid=17684188 |doi=10.1001/jama.298.6.655}}</ref> | ||
== Rituximab == | |||
Currently rituximab in patient with Eosinophilic granulomatosis with polyangiitis in not licensed for use and studies are required for its effectiveness. | |||
== Intravenous Immunoglobulins == | |||
In Eosinophilic granulomatosis with polyangiitis IV immungoglobulins, are used as a second-line therapy. They are administered in conjunction with glucocorticoids alone or glucocorticoids + immunosuppressive agents, to patients who experience flare-ups do to certain medications they take or during pregnancy. | |||
== References == | |||
==References== | |||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:45, 16 November 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Eosinophilic granulomatosis with polyangiitis responds well to treatment with glucocorticoids such as prednisone when the disease is not in a life threatening state. The dose of glucocorticoid that is given is 1 mg/kg/day for 2-3 weeks. Patients who are unable to taper the dose of glucocorticoid less than 7.5 mg/day for 3 to 4 months. Patients not responding to tapered doses can be given a glucocorticoid-sparing agent. These agents include methotrexate,azathioprine,hydroxyurea, and meclophenalate mofetil.[1] [2] [3]
Patients who present with a life threating form of the disease are treated with cyclophosphamide together with glucocorticoid. The dosage that is given is 1 mg/kg/day for 2-3 weeks and then slowly tapered to a minimal effective dose. Cyclophosphamide is dosed at 2mg/kg/day as an oral or intravenous dose. Cyclophosphamide may also be administered via pulse infusions at 15mg/kg every 2 weeks for the first three infusions. Following the 3 infusions of cyclophosphamide, cyclophosphamide is infused at 15 mg/kg every 3 weeks. Infused doses of cyclophosphamide should not exceed doses of 1.2 g. Patients receive 6 to 12 pulse infusions of cyclophosphamide.
The maintenance therapy of Eosinophilic granulomatosis with polyangiitis that presents as life threating, patients are treated with azathioprine or methotrexate. Treatment with either of these two agents is given as follows:
| Maintenance therapy | Azathioprine | Methotrexate |
|---|---|---|
| 2 mg/kg/day | 10-30 mg/wk |
Either of these treatments can be given after a few days of oral cyclophosphamide; to 2 to 3 weeks after pulse administrative doses. The time frame at which these medications are to be administered to is currently unknown; however, 18-24 months of remission of these 2 agents have been noted.[4] According to Sanders et al, 2005 at 18 months the relapse rate of azathioprine is 13.3% and at 5 years the relapse rate is 62.3% respectively.[5]
Rituximab
Currently rituximab in patient with Eosinophilic granulomatosis with polyangiitis in not licensed for use and studies are required for its effectiveness.
Intravenous Immunoglobulins
In Eosinophilic granulomatosis with polyangiitis IV immungoglobulins, are used as a second-line therapy. They are administered in conjunction with glucocorticoids alone or glucocorticoids + immunosuppressive agents, to patients who experience flare-ups do to certain medications they take or during pregnancy.
References
- ↑ Assaf C, Mewis G, Orfanos CE, Geilen CC (2004). "Churg-Strauss syndrome: successful treatment with mycophenolate mofetil". Br J Dermatol. 150 (3): 598–600. doi:10.1111/j.1365-2133.2003.05807.x. PMID 15030353.
- ↑ Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V; et al. (2015). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management". Eur J Intern Med. 26 (7): 545–53. doi:10.1016/j.ejim.2015.04.022. PMID 25971154.
- ↑ Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V; et al. (2015). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management". Eur J Intern Med. 26 (7): 545–53. doi:10.1016/j.ejim.2015.04.022. PMID 25971154.
- ↑ Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V; et al. (2015). "Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management". Eur J Intern Med. 26 (7): 545–53. doi:10.1016/j.ejim.2015.04.022. PMID 25971154.
- ↑ Bosch X, Guilabert A, Espinosa G, Mirapeix E (2007). "Treatment of antineutrophil cytoplasmic antibody associated vasculitis: a systematic review". JAMA. 298 (6): 655–69. doi:10.1001/jama.298.6.655. PMID 17684188.