Abstract
Treatment strategies for anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are evolving. Cyclophosphamide (CYC) plus corticosteroids (CSs) is the mainstay of therapy for generalized, multisystemic AAV. Historically, the combination of CYC plus CS was used for a minimum of 12 months, but concern about late toxicities associated with CYC has led to novel treatment approaches. Currently, short-course (3 to 6 months) induction treatment with CYC plus CS, followed by maintenance therapy with less toxic agents (eg, methotrexate, azathioprine, mycophenolate mofetil) is recommended. Further, methotrexate combined with CS may be adequate for limited, non-life-threatening AAV. Recent studies suggest that rituximab may be useful for induction therapy or for CYC-refractory AAV. This article reviews the key agents used to treat AAV, with a focus on pharmacology, toxicities, and monitoring.
© Thieme Medical Publishers.
MeSH terms
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Adrenal Cortex Hormones / administration & dosage*
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Adrenal Cortex Hormones / adverse effects
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Adrenal Cortex Hormones / pharmacology
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Adrenal Cortex Hormones / therapeutic use
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Anti-Inflammatory Agents* / administration & dosage
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Anti-Inflammatory Agents* / adverse effects
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Anti-Inflammatory Agents* / pharmacology
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Anti-Inflammatory Agents* / therapeutic use
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Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy*
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Azathioprine / administration & dosage
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Azathioprine / adverse effects
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Azathioprine / pharmacology
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Azathioprine / therapeutic use
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Cyclophosphamide / pharmacology
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Cyclophosphamide / therapeutic use
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Humans
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Immunosuppressive Agents* / administration & dosage
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Immunosuppressive Agents* / adverse effects
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Immunosuppressive Agents* / pharmacology
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Immunosuppressive Agents* / therapeutic use
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Methotrexate / pharmacology
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Methotrexate / therapeutic use
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Mycophenolic Acid / administration & dosage
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Mycophenolic Acid / adverse effects
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Mycophenolic Acid / analogs & derivatives
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Mycophenolic Acid / pharmacology
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Mycophenolic Acid / therapeutic use
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Time Factors
Substances
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Adrenal Cortex Hormones
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Anti-Inflammatory Agents
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Immunosuppressive Agents
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Cyclophosphamide
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Mycophenolic Acid
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Azathioprine
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Methotrexate