[Update on treatment of ANCA-associated vasculitis].

Therapie-Update der ANCA-assoziierten Vaskulitiden.

AAV Benralizumab Biologics Mepolizumab Rituximab

Journal

Zeitschrift fur Rheumatologie

ISSN: 1435-1250

Titre abrégé: Z Rheumatol

Pays: Germany

ID NLM: 0414162

Informations de publication

Date de publication:
28 Aug 2024

Historique:

accepted: 19 06 2024

medline: 28 8 2024

pubmed: 28 8 2024

entrez: 28 8 2024

Statut: aheadofprint

Résumé

This article summarizes the current guidelines and recommendations published by the European Alliance of Associations for Rheumatology (EULAR), the Kidney Disease Improving Global Outcomes (KDIGO) and the American College of Rheumatology (ACR). In addition to glucocorticoids (GC), treatment with biologics is nowadays an established option to treat Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis (AAV). Rituximab (RTX) is used for remission induction and maintenance in organ-threatening and non-organ-threatening granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). For eosinophilic GPA (EGPA) anti-interleukin 5 (IL5) strategies are an important component of treatment for remission induction and maintenance of refractory or relapsing non-organ-threatening diseases in conjunction with GC. The dosing of GC for remission induction in GPA and MPA is now lower than was previously used and additionally, avacopan is approved as a new GC-sparing medication for GPA and MPA over 52 weeks. Conventional strategies, such as cyclophosphamide (CYC) are important for remission induction in severe or refractory organ-threatening disease for all AAVs. The use of methotrexate (MTX) and azathioprine (AZA) is becoming less prominent. The most important unanswered questions in the treatment of AAVs are with respect to the duration of remission maintenance treatment and the individualized treatment guidance based on biomarkers. Dieser Beitrag fasst die aktuellen Leitlinien und Empfehlungen der EULAR (European Alliance of Associations for Rheumatology) sowie der KDIGO (Kidney Disease Improving Global Outcomes) bzw. des ACR (American College of Rheumatology) zusammen. Biologikatherapien stellen heutzutage neben Glukokortikoiden (GC) eine etablierte Säule in der Therapie der ANCA(Antineutrophile Zytoplasmatische Antikörper)-assoziierten Vaskulitiden (AAV) dar. So wird Rituximab (RTX) sowohl zur Remissionsinduktion und -erhaltung bei organbedrohender und nicht organbedrohender Granulomatose mit Polyangiitis (GPA) und Mikroskopischer Polyangiitis (MPA) angewendet. Bei der Eosinophilen Granulomatose mit Polyangiitis (EGPA) sind Anti-IL(Interleukin)-5-Strategien für die Remissionsinduktion und -erhaltung bei refraktärer oder rezidivierender nicht organbedrohender Erkrankung als wesentlicher Therapiebaustein neben den GC anzusehen. Die GC-Dosierung im Rahmen der Remissionsinduktion erfolgt heute bei GPA/MPA niedriger als früher üblich, zudem ist Avacopan als neues GC-einsparendes Medikament bei GPA/MPA über 52 Wochen zugelassen. Konventionelle Strategien wie Cyclophosphamid (CYC) haben einen Stellenwert für alle AAV zur Remissionsinduktion bei schwerer oder refraktärer organbedrohender Erkrankung. Die Anwendung von Methotrexat (MTX) und Azathioprin (AZA) rückt zunehmend in den Hintergrund. Die wichtigsten unbeantworteten Fragen in der Therapie der AAV beziehen sich auf die Dauer der remissionserhaltenden Therapie und die individualisierte Therapiesteuerung anhand von Biomarkern.

Autres résumés

Type: Publisher (ger)

Dieser Beitrag fasst die aktuellen Leitlinien und Empfehlungen der EULAR (European Alliance of Associations for Rheumatology) sowie der KDIGO (Kidney Disease Improving Global Outcomes) bzw. des ACR (American College of Rheumatology) zusammen. Biologikatherapien stellen heutzutage neben Glukokortikoiden (GC) eine etablierte Säule in der Therapie der ANCA(Antineutrophile Zytoplasmatische Antikörper)-assoziierten Vaskulitiden (AAV) dar. So wird Rituximab (RTX) sowohl zur Remissionsinduktion und -erhaltung bei organbedrohender und nicht organbedrohender Granulomatose mit Polyangiitis (GPA) und Mikroskopischer Polyangiitis (MPA) angewendet. Bei der Eosinophilen Granulomatose mit Polyangiitis (EGPA) sind Anti-IL(Interleukin)-5-Strategien für die Remissionsinduktion und -erhaltung bei refraktärer oder rezidivierender nicht organbedrohender Erkrankung als wesentlicher Therapiebaustein neben den GC anzusehen. Die GC-Dosierung im Rahmen der Remissionsinduktion erfolgt heute bei GPA/MPA niedriger als früher üblich, zudem ist Avacopan als neues GC-einsparendes Medikament bei GPA/MPA über 52 Wochen zugelassen. Konventionelle Strategien wie Cyclophosphamid (CYC) haben einen Stellenwert für alle AAV zur Remissionsinduktion bei schwerer oder refraktärer organbedrohender Erkrankung. Die Anwendung von Methotrexat (MTX) und Azathioprin (AZA) rückt zunehmend in den Hintergrund. Die wichtigsten unbeantworteten Fragen in der Therapie der AAV beziehen sich auf die Dauer der remissionserhaltenden Therapie und die individualisierte Therapiesteuerung anhand von Biomarkern.

Identifiants

DOI: 10.1007/s00393-024-01548-1 PMID: 39196354

pubmed: 39196354

doi: 10.1007/s00393-024-01548-1

pii: 10.1007/s00393-024-01548-1

doi:

Types de publication

English Abstract Journal Article Review

Langues

ger

Sous-ensembles de citation

Informations de copyright

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