Is newer safer? Adverse events associated with first-line therapies for ANCA-associated vasculitis and lupus nephritis.
Clinical outcomes in ANCA-associated vasculitis (AAV) and lupus nephritis have improved greatly with treatment regimens containing high-dose glucocorticoids and cyclophosphamide. However, with the use of these medications come significant adverse events, most notably infections, cytopenias, malignancies, and reproductive abnormalities. Multiple recent randomized controlled trials in AAV and lupus nephritis have compared cyclophosphamide-based regimens with agents such as rituximab, mycophenolate mofetil, and azathioprine, with the hope of providing better clinical outcomes with improved safety profiles. Although some of these newer regimens are now considered first-line treatments of these diseases, their adverse event profiles have been disappointingly similar to those of cyclophosphamide-based protocols. Physicians and patients should consider the adverse event profiles generated by these trials in the context of their extensive use in other patient populations, as well as available measures to prevent such events, when choosing the ideal regimen for an individual patient.
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York jjh2165@cumc.columbia.edu.
Jonathan
J
Hogan
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York.
Rupali
R
Avasare
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York.
Jai
J
Radhakrishnan
D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008181:Lupus Nephritis / Q000188:drug therapy*; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D016032:Randomized Controlled Trials as Topic; D000069283:Rituximab
D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D009173:Mycophenolic Acid
glomerulonephritis; immunosuppression; rheumatology