Novel therapies for anti-neutrophil cytoplasmic antibody-associated vasculitis.
High-dose corticosteroids in combination with cytotoxic drugs are universally accepted as the initial approach in vasculitides that are associated with anti-neutrophil cytoplasmic antibodies. Cyclophosphamide is the most effective cytotoxic drug and is used in more severe cases. Because cyclophosphamide has more severe short- and long-term side-effects than methotrexate, methotrexate is used in less severe cases. New prospects for the treatment of vasculitis include novel immunosuppressive agents (e.g. mycophenolate, 15-deoxyspergualin, and leflunomide), sequential chemotherapy (e.g. cyclophosphamide followed by azathioprine or cyclophosphamide followed by methotrexate), intravenous immunoglobulin, tumour necrosis factor-alpha directed therapy, anti-lymphocyte directed therapy (e.g. antithymocyte globulin or anti CD52/anti CD4 antibodies), anti-adhesion molecule directed therapy (e.g. anti-CD18 or intercellular adhesion molecule-1 antisense) or immunoablation using high-dose cytotoxic medication with or without stem cell rescue.
University Hospital Maastricht, Department of Clinical and Experimental Immunology, Maastricht, the Netherlands. jw.cohentervaert@immuno.unimaas.nl
J W
JW
Tervaert
C A
CA
Stegeman
C G
CG
Kallenberg
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000378:metabolism*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D006146:Guanidines / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D018799:Intercellular Adhesion Molecule-1 / Q000276:immunology; D007555:Isoxazoles / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy / Q000276:immunology; D000077339:Leflunomide; D008727:Methotrexate / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012074:Remission Induction; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014657:Vasculitis / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*
D019268:Antibodies, Antineutrophil Cytoplasmic; D000961:Antilymphocyte Serum; D006146:Guanidines; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D014409:Tumor Necrosis Factor-alpha; D018799:Intercellular Adhesion Molecule-1; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003520:Cyclophosphamide; D000077339:Leflunomide; D009173:Mycophenolic Acid; C037258:gusperimus; D011241:Prednisone; D008727:Methotrexate