title: Getting the balance right: adverse events of therapy in anti-neutrophil cytoplasm antibody vasculitis.
abstract: Antineutrophil cytoplasm antibody associated systemic vasculitides (AASV) have traditionally been managed with a combination of cyclophosphamide and glucocorticoids during the induction phase, followed by azathioprine in the maintenance phase. Whilst these therapies have markedly improved the prognosis in AASV, treatment related adverse events remain a major challenge and include complications such as infection, glucocorticoid related side effects, malignancy, cardiovascular disease, infertility and death. Newer biologic therapies have been shown to demonstrate equivalent efficacy as cyclophosphamide for remission but the hoped for reduction in adverse events has yet to be realised. More recent efforts have been focused on refining existing therapeutic regimens and strategies, tailoring individual treatment to disease severity, patient age and kidney function to derive maximum treatment efficacy while minimising treatment toxicity. In particular, current interventional trials are targeting a reduction in corticosteroid exposure in an effort to make induction and maintenance regimens safer.
authors.affiliation: Trinity Health Kidney Centre, Tallaght Hospital and Trinity College, Dublin, Ireland.
authors.forename: Limy
authors.initials: L
authors.lastname: Wong
authors.affiliation: Division of Medical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
authors.affiliation: Trinity Health Kidney Centre, Tallaght Hospital and Trinity College, Dublin, Ireland.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Little
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: adverse events; treatment; vasculitis