Microscopic polyangiitis medical therapy: Difference between revisions

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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]].<ref name="pmid20235186">{{cite journal |vauthors=Walsh M, Merkel PA, Mahr A, Jayne D |title=Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis |journal=Arthritis Care Res (Hoboken) |volume=62 |issue=8 |pages=1166–73 |date=August 2010 |pmid=20235186 |pmc=2946200 |doi=10.1002/acr.20176 |url=}}</ref>  
* 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.   

Revision as of 19:57, 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

Corticosteroids:

  • In more aggressive forms of the disease prednisone is interchanged with methylprednisolone.[2]
  • 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.

Rituximab

Maintenance Therapy

  • 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

  1. 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.
  2. Walsh M, Merkel PA, Mahr A, Jayne D (August 2010). "Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis". Arthritis Care Res (Hoboken). 62 (8): 1166–73. doi:10.1002/acr.20176. PMC 2946200. PMID 20235186.
  3. 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.

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