Remission maintenance in ANCA-associated vasculitis: does one size fit all?

Alvise Berti, Ulrich Specks

Research output: Contribution to journalReview article

Abstract

Introduction: The majority of the patients with anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) achieve remission with effective induction therapy. Therefore, prevention of relapses and avoiding long-term damage and treatment-related toxicity are major challenges. Areas covered: This review provides an update on maintenance therapy in AAV, emphasizing the available treatment options for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Among the spectrum of all patients with AAV, those at higher risk of relapse have recently been identified. Clinical trials have yielded robust results about various options for maintenance of remission including common disease-modifying anti-rheumatic drugs (DMARDs, i.e. azathioprine, methotrexate, and mycophenolate mofetil) and rituximab (RTX). However, outcomes of these studies are not easy to compare. Expert opinion: Regardless of the treatment used, patients presenting with an anti-proteinase-3 ANCA, relapsing GPA have a substantially higher risk of relapse compared to patients with newly diagnosed MPA or positive anti-myeloperoxidase ANCA. While the efficacy of common DMARDs for remission maintenance is heterogeneous, the role of RTX seems particularly promising for the high-risk patients, although the most appropriate dose and timing of retreatment with RTX remain under controversial. Low-dose glucocorticoid use for remission maintenance versus complete discontinuation also remains under investigation.

Original languageEnglish (US)
Pages (from-to)1273-1286
Number of pages14
JournalExpert Review of Clinical Immunology
Volume15
Issue number12
DOIs
StatePublished - Dec 2 2019

Fingerprint

Vasculitis
Autoantibodies
Neutrophils
Maintenance
Antirheumatic Agents
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Microscopic Polyangiitis
Granulomatosis with Polyangiitis
Myeloblastin
Mycophenolic Acid
Therapeutics
Recurrence
Retreatment
Azathioprine
Expert Testimony
Secondary Prevention
Methotrexate
Glucocorticoids
Peroxidase
Outcome Assessment (Health Care)

Keywords

  • ANCA
  • ANCA-associated vasculitis
  • Azathioprine
  • Maintenance therapy
  • RAVE
  • Rituximab
  • vasculitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Remission maintenance in ANCA-associated vasculitis : does one size fit all? / Berti, Alvise; Specks, Ulrich.

In: Expert Review of Clinical Immunology, Vol. 15, No. 12, 02.12.2019, p. 1273-1286.

Research output: Contribution to journalReview article

@article{7c39691add9646c5b0a9cf13d70bdb95,
title = "Remission maintenance in ANCA-associated vasculitis: does one size fit all?",
abstract = "Introduction: The majority of the patients with anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) achieve remission with effective induction therapy. Therefore, prevention of relapses and avoiding long-term damage and treatment-related toxicity are major challenges. Areas covered: This review provides an update on maintenance therapy in AAV, emphasizing the available treatment options for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Among the spectrum of all patients with AAV, those at higher risk of relapse have recently been identified. Clinical trials have yielded robust results about various options for maintenance of remission including common disease-modifying anti-rheumatic drugs (DMARDs, i.e. azathioprine, methotrexate, and mycophenolate mofetil) and rituximab (RTX). However, outcomes of these studies are not easy to compare. Expert opinion: Regardless of the treatment used, patients presenting with an anti-proteinase-3 ANCA, relapsing GPA have a substantially higher risk of relapse compared to patients with newly diagnosed MPA or positive anti-myeloperoxidase ANCA. While the efficacy of common DMARDs for remission maintenance is heterogeneous, the role of RTX seems particularly promising for the high-risk patients, although the most appropriate dose and timing of retreatment with RTX remain under controversial. Low-dose glucocorticoid use for remission maintenance versus complete discontinuation also remains under investigation.",
keywords = "ANCA, ANCA-associated vasculitis, Azathioprine, Maintenance therapy, RAVE, Rituximab, vasculitis",
author = "Alvise Berti and Ulrich Specks",
year = "2019",
month = "12",
day = "2",
doi = "10.1080/1744666X.2020.1693260",
language = "English (US)",
volume = "15",
pages = "1273--1286",
journal = "Expert Review of Clinical Immunology",
issn = "1744-666X",
publisher = "Expert Reviews Ltd.",
number = "12",

}

TY - JOUR

T1 - Remission maintenance in ANCA-associated vasculitis

T2 - does one size fit all?

AU - Berti, Alvise

AU - Specks, Ulrich

PY - 2019/12/2

Y1 - 2019/12/2

N2 - Introduction: The majority of the patients with anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) achieve remission with effective induction therapy. Therefore, prevention of relapses and avoiding long-term damage and treatment-related toxicity are major challenges. Areas covered: This review provides an update on maintenance therapy in AAV, emphasizing the available treatment options for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Among the spectrum of all patients with AAV, those at higher risk of relapse have recently been identified. Clinical trials have yielded robust results about various options for maintenance of remission including common disease-modifying anti-rheumatic drugs (DMARDs, i.e. azathioprine, methotrexate, and mycophenolate mofetil) and rituximab (RTX). However, outcomes of these studies are not easy to compare. Expert opinion: Regardless of the treatment used, patients presenting with an anti-proteinase-3 ANCA, relapsing GPA have a substantially higher risk of relapse compared to patients with newly diagnosed MPA or positive anti-myeloperoxidase ANCA. While the efficacy of common DMARDs for remission maintenance is heterogeneous, the role of RTX seems particularly promising for the high-risk patients, although the most appropriate dose and timing of retreatment with RTX remain under controversial. Low-dose glucocorticoid use for remission maintenance versus complete discontinuation also remains under investigation.

AB - Introduction: The majority of the patients with anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) achieve remission with effective induction therapy. Therefore, prevention of relapses and avoiding long-term damage and treatment-related toxicity are major challenges. Areas covered: This review provides an update on maintenance therapy in AAV, emphasizing the available treatment options for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Among the spectrum of all patients with AAV, those at higher risk of relapse have recently been identified. Clinical trials have yielded robust results about various options for maintenance of remission including common disease-modifying anti-rheumatic drugs (DMARDs, i.e. azathioprine, methotrexate, and mycophenolate mofetil) and rituximab (RTX). However, outcomes of these studies are not easy to compare. Expert opinion: Regardless of the treatment used, patients presenting with an anti-proteinase-3 ANCA, relapsing GPA have a substantially higher risk of relapse compared to patients with newly diagnosed MPA or positive anti-myeloperoxidase ANCA. While the efficacy of common DMARDs for remission maintenance is heterogeneous, the role of RTX seems particularly promising for the high-risk patients, although the most appropriate dose and timing of retreatment with RTX remain under controversial. Low-dose glucocorticoid use for remission maintenance versus complete discontinuation also remains under investigation.

KW - ANCA

KW - ANCA-associated vasculitis

KW - Azathioprine

KW - Maintenance therapy

KW - RAVE

KW - Rituximab

KW - vasculitis

UR - http://www.scopus.com/inward/record.url?scp=85075382482&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075382482&partnerID=8YFLogxK

U2 - 10.1080/1744666X.2020.1693260

DO - 10.1080/1744666X.2020.1693260

M3 - Review article

C2 - 31762340

AN - SCOPUS:85075382482

VL - 15

SP - 1273

EP - 1286

JO - Expert Review of Clinical Immunology

JF - Expert Review of Clinical Immunology

SN - 1744-666X

IS - 12

ER -