Microscopic polyangiitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Microscopic polyangiitis}} | {{Microscopic polyangiitis}} | ||
{{CMG}}{{APM}}{{AE}}{{KW}} | {{CMG}}{{APM}}{{AE}}{{KW}} ; {{VKG}} | ||
==Overview== | ==Overview== | ||
Microscopic polyangiitis responds well to treatment with glucocorticoids such as prednisone together with | 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 == | ||
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=== '''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 | ||
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* 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. | |||
=== '''Rituximab''' === | === '''Rituximab''' === | ||
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== 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. | |||
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 | ||
* Methotrexate: 0.3 to 25 mg/kg/week | ** Preferred regimen (2): Methotrexate: 0.3 to 25 mg/kg/week | ||
==References== | ==References== | ||
Revision as of 19:42, 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.