Microscopic polyangiitis medical therapy
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Microscopic polyangiitis Microchapters |
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Differentiating Microscopic polyangiitis from other Diseases |
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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]
Overview
Microscopic polyangiitis responds well to treatment with glucocorticoids such as prednisone together with a immunosuppressant such as cyclophosphamide. The combination of these 2 drugs decreases the remission of Microscopic polyangiitis by about 90%.
Medical Therapy
Induction ( 2 to 6 months)
Microscopic polyangiitis responds well to treatment with glucocorticoids such as prednisone together with a immunosuppressant such as cyclophosphamide. The dose of prednisone that is given is 1 mg/kg/day for less aggressive forms of the disease. In more aggressive forms of the disease prednisone is interchanged with methylprednisolone which is given intravenously at a dose of 1 g/kg 3 times a day. Both mild and severe forms of the disease are administered together with cyclophosphamide which is given in intravenous pulses every 2 weeks at a dose of 15 mg/kg for the first three infusions. After the first 3 doses cyclophosphamide is administered every 3 weeks at 15 mg/kg. 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.
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.
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 at a dose of 1 to 2 mg/kg/day.
Other medications that may be used as maintenance are:
- Myclophenolate mofetil: up to 1g twice a day
- Methotrexate: 0.3 to 25 mg/kg/week