Microscopic polyangiitis medical therapy: Difference between revisions
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{{CMG}}{{APM}}{{AE}}{{KW}} ; {{VKG}} | {{CMG}}{{APM}}{{AE}}{{KW}} ; {{VKG}} | ||
==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%. | [[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.<ref name="pmid25992801">{{cite journal| author=Greco A, De Virgilio A, Rizzo MI, Gallo A, Magliulo G, Fusconi M et al.| title=Microscopic polyangiitis: Advances in diagnostic and therapeutic approaches. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 9 | pages= 837-44 | pmid=25992801 | doi=10.1016/j.autrev.2015.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25992801 }}</ref> | * Pharmacologic medical therapies for [[Microscopic polyangiitis]] include [[glucocorticoids]] and [[immunosuppressant]].<ref name="pmid25992801">{{cite journal| author=Greco A, De Virgilio A, Rizzo MI, Gallo A, Magliulo G, Fusconi M et al.| title=Microscopic polyangiitis: Advances in diagnostic and therapeutic approaches. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 9 | pages= 837-44 | pmid=25992801 | doi=10.1016/j.autrev.2015.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25992801 }}</ref> | ||
=== '''Corticosteroids:''' === | === '''Corticosteroids:''' === | ||
* In more aggressive forms of the disease prednisone is interchanged with methylprednisolone. | * 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. | * 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. | * 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. | * [[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 | * 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. | * 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. | * [[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 (1): [[Methylprednisolone]] 1g/kg 3 times a day. | ||
** Preferred regimen (2): Cyclophosphamide 15 mg/kg. | ** Preferred regimen (2): [[Cyclophosphamide]] 15 mg/kg. | ||
=== '''Rituximab''' === | === '''Rituximab''' === | ||
* Induction therapy using rituximab and glucocorticoids in a recent study conducted by RITUXVAS compared rituximab and cyclophosphamide.<ref name="pmid18281850">{{cite journal |vauthors=Jayne D |title=Challenges in the management of microscopic polyangiitis: past, present and future |journal=Curr Opin Rheumatol |volume=20 |issue=1 |pages=3–9 |date=January 2008 |pmid=18281850 |doi=10.1097/BOR.0b013e3282f370d1 |url=}}</ref> | * Induction therapy using [[rituximab]] and [[glucocorticoids]] in a recent study conducted by RITUXVAS compared [[rituximab]] and [[cyclophosphamide]].<ref name="pmid18281850">{{cite journal |vauthors=Jayne D |title=Challenges in the management of microscopic polyangiitis: past, present and future |journal=Curr Opin Rheumatol |volume=20 |issue=1 |pages=3–9 |date=January 2008 |pmid=18281850 |doi=10.1097/BOR.0b013e3282f370d1 |url=}}</ref> | ||
* 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. | * 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. | * 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. | ** Preferred regimen (1):[[Azathioprine]] 1 to 2 mg/kg/day. | ||
* Other medications that may be used as maintenance are: | * Other medications that may be used as maintenance are: | ||
** Preferred regimen (1): Mycophenolate mofetil up to 1g twice a day | ** Preferred regimen (1): [[Mycophenolate]] mofetil up to 1g twice a day. | ||
** Preferred regimen (2): Methotrexate: 0.3 to 25 mg/kg/week | ** Preferred regimen (2): [[Methotrexate]]: 0.3 to 25 mg/kg/week. | ||
==References== | ==References== | ||
Revision as of 19:45, 27 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2]Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3] ; Vamsikrishna Gunnam M.B.B.S [4]
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.[1]
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.[2]
- 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.
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.
- ↑ 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.