title: Maintenance therapy in antineutrophil cytoplasmic antibody-associated vasculitis: who needs what and for how long?
abstract: Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitides (AAV) are severe chronic auto-immune diseases in which the small vessels are inflamed. Nowadays, in the majority of patients disease can be brought into remission with cyclophosphamide and corticosteroids. However, depending upon disease characteristics patients with AAV have a risk of 29-60% to experience relapses of disease within 5 years despite maintenance therapy after induction of remission with less toxic agents, such as azathioprine, methotrexate or mycophenolate mofetil. More recently, rituximab has been found effective in both induction and maintenance of remission in AAV. This review discusses the different aspects of maintenance therapy in AAV based on reported cohorts and studies, including the different agents, therapy duration, efficacy or lack thereof and future directions. Finally, recommendations are made who to treat and for how long.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Anoek A E
authors.initials: AA
authors.lastname: de Joode
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Jan Stephan F
authors.initials: JS
authors.lastname: Sanders
authors.affiliation: Department of Clinical Immunology and Rheumatology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Abraham
authors.initials: A
authors.lastname: Rutgers
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Stegeman
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents
keywords: ANCA; GPA; MPA; maintenance; vasculitis