Induction and maintenance of remission with mycophenolate mofetil in ANCA-associated vasculitis: a systematic review and meta-analysis

Berti, Alvise; Alsawas, Mouaz; Jawaid, Tabinda; Prokop, Larry J.; Lee, Jiwon M.; Jeong, Gwang Hun; Quintana, Luís F.; Moiseev, Sergey; Vaglio, A; Tesař, Vladimı́r; Geetha, Duvuru; Shin, Jae Il; Kronbichler, Andreas

doi:10.1093/ndt/gfab357

Cited by 16 publications

(8 citation statements)

References 30 publications

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“…Based on these considerations, EULAR [ 20 ] proposed that, for remission maintenance, CYC should be replaced by a combination of GC and other, less toxic immunosuppressive agents such as azathioprine [ 49 ], MTX [ 47 ], or MMF [ 50 ]. However, even after 2 years of remission maintenance therapy with these agents, the rate of relapse is relatively high [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

The eye is a common site of granulomatosis with polyangiitis. A collaborative study

et al. 2023

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Background Ocular manifestations of granulomatosis with polyangiitis (GPA) have been reported in a limited number of studies and with largely variable frequency. Here we report on the clinical, diagnostic, and therapeutic features of a cohort of 63 GPA patients, with particular regard to 22 of them with ophthalmic involvement (35%). Methods Clinical manifestations, results of immunological findings, histopathological pictures, imaging data, Birmingham Vasculitis Activity Score, therapeutic regimens, and outcomes were retrospectively analyzed. At diagnosis, in addition to a structured clinical assessment, all patients underwent a comprehensive ophthalmologic examination. Results The most frequently involved organs were kidneys, lungs, ear/nose/throat, and eyes. Ocular manifestations were bilateral in 32%. The three most commonly diagnosed ophthalmologic manifestations were scleritis (36%), retro-orbital pseudotumor or orbital mass (23%), and episcleritis (13%). Ocular and systemic involvement were simultaneously present at onset in 41% of the patients; systemic involvement was followed by ocular lesions in 36%; ocular inflammation was followed by systemic manifestations in 18%; and an orbital mass in the absence of systemic disease characterized 5%. Glucocorticoids plus cyclophosphamide and glucocorticoids plus rituximab were the combined therapies most frequently employed during remission induction and remission maintenance, respectively. Persistent ophthalmologic and extra-ocular remissions were achieved in 77 and 64% of the patients, respectively. One to three systemic relapses were diagnosed in 7 patients (31.8%). At the last follow-up, a visual outcome 20/40 or better in 31 (70%) of 44 eyes was determined. Conclusions The eye was involved in over one third of our patients with GPA. Increased awareness, early diagnosis, and multi-specialty collaboration are critical in achieving a favorable outcome of GPA.

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Section: Discussionmentioning

confidence: 99%

The eye is a common site of granulomatosis with polyangiitis. A collaborative study

et al. 2023

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“…The patient then developed pulmonary mould infection, and CTX was replaced by Tripterygium glycosides with persistent disease activity. Referring to the literature[ 4 ], where MMF was proven to be effective for the induction of remission in AAV, the patient was then treated with MMF, but the efficacy remained poor. In addition, given the low B-lymphocyte level and a history of deep mould infection, rituximab was not considered.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of granulomatosis with polyangiitis using tocilizumab combined with glucocorticoids: A case report

Tang¹,

Xu²,

Hong³

et al. 2023

World J Clin Cases

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BACKGROUND Tocilizumab is a humanized monoclonal antibody against the interleukin-6 (IL-6) receptor that is commonly used to treat large vessel vasculitis and antineutrophil cytoplasmic antibody-related small vessel vasculitis. However, tocilizumab in combination with glucocorticoids for successfully treating granulomatosis with polyangiitis (GPA) has rarely been reported. CASE SUMMARY Here, we report a 40-year-old male patient who suffered GPA for 4 years. He was treated with multiple rounds of drugs, including cyclophosphamide, Tripterygium wilfordii, mycophenolate mofetil, and belimumab, with no improvement. In addition, he exhibited persistently high IL-6 levels. After tocilizumab treatment, his symptoms improved, and his inflammatory marker levels returned to normal. CONCLUSION Tocilizumab may be effective for treating GPA.

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“…MMF efficacy in patients with non-severe kidney disease has been demonstrated in clinical trials [ 43–47 ]. MMF was associated with higher sustained remission rates in patients with AAV-GN included in clinical trials [ 48 ], but concerns regarding the increased rates of relapse when compared with CYC have been raised [ 46 , 47 ]. MYCYC, an RCT comparing MMF with CYC showed non-inferiority of MMF in inducing remission at 6 months although relapses occurred more frequently in patients with proteinase 3 (PR3)-ANCA vasculitis treated with MMF [ 46 ].…”

Section: Remission-induction Treatment In Patients With Non-organ-/li...mentioning

confidence: 99%

Management of antineutrophil cytoplasmic antibody–associated vasculitis with glomerulonephritis as proposed by the ACR 2021, EULAR 2022 and KDIGO 2021 guidelines/recommendations

Moura

Gauckler

Anders

et al. 2023

Nephrology Dialysis Transplantation

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Updated guidelines on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were released in 2021 by the American College of Rheumatology jointly with the Vasculitis Foundation and, subsequently, in 2022 by the European Alliance of Associations for Rheumatology. In addition, in 2021, the Kidney Disease: Improving Global Outcomes had released updated recommendations on the treatment of AAV with glomerulonephritis (AAV-GN). Kidney involvement is particularly relevant in microscopic polyangiitis and granulomatosis with polyangiitis, but is less frequent in eosinophilic granulomatosis with polyangiitis. The management of AAV-GN has been a focus for drug development and change over the past ten years. Avoidance of progression to end-stage kidney disease (ESKD) or kidney failure is one of the main unmet needs in the management of AAV, with ESKD having a major impact on morbidity, health costs and mortality risk. Relevant changes in AAV-GN management are related to remission-induction treatment of patients with severe kidney disease, the use of glucocorticoids, avacopan and remission-maintenance treatment. All the documents provide guidance in accordance with the evidence-based standard of care available at the time of their release. With our work we aim to (i) show the progress made and identify the differences between guidelines and recommendations, (ii) discuss the supporting rationale for those, and (iii) identify gaps in knowledge that could benefit from additional research and should be revised in subsequent updates.

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Induction and maintenance of remission with mycophenolate mofetil in ANCA-associated vasculitis: a systematic review and meta-analysis

Cited by 16 publications

References 30 publications

The eye is a common site of granulomatosis with polyangiitis. A collaborative study

The eye is a common site of granulomatosis with polyangiitis. A collaborative study

Successful treatment of granulomatosis with polyangiitis using tocilizumab combined with glucocorticoids: A case report

Management of antineutrophil cytoplasmic antibody–associated vasculitis with glomerulonephritis as proposed by the ACR 2021, EULAR 2022 and KDIGO 2021 guidelines/recommendations

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