Update on the treatment of ANCA associated vasculitis

Smith, Rona

doi:10.1016/j.lpm.2015.04.008

Cited by 17 publications

(6 citation statements)

References 83 publications

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“…AntineutRophil cytoplAsm Antibody AssociAted vAsculitis B cells are thought to play an essential role in the pathogenesis of AAV. Not only are B cells the precursors of ANCA secreting plasma cells, but they also act as antigen presenting cells for auto-reactive T cells, providing co-stimulatory support and T cells activation 16 .…”

Section: Discussionmentioning

confidence: 99%

Rituximab use in adult glomerulopathies and its rationale

et al. 2020

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Glomerulopathies are one of the leading causes of end-stage renal disease. In the last years, clinical research has made significant contributions to the understanding of such conditions. Recently, rituximab (RTX) has appeared as a reasonably safe treatment. The Kidney Disease: Improving Global Outcomes guidelines (KDIGO) recommended RTX only as initial treatment in antineutrophil cytoplasm antibody associated vasculitis (AAV) and in non-responders patients with lupus nephritis (LN), but these guidelines have not been updated since 2012. Nowadays, RTX seems to be at least as effective as other immunosuppressive regimens in idiopathic membranous nephropathy (IMN). In minimal-change disease, (MCD) this drug might allow a long-lasting remission period in steroid-dependent or frequently relapsing patients. Preliminary results support the use of RTX in patients with pure membranous LN and immunoglobulin-mediated membranoproliferative glomerulonephritis (MPGN), but not in patients with class III/IV LN or complement-mediated MPGN. No conclusion can be drawn in idiopathic focal segmental glomerulosclerosis (FSGS) and anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN) because studies are small, heterogeneous, and scarce. Lastly, immunosuppression including RTX is not particularly useful in IgA nephropathy. This review presents the general background, outcomes, and safety for RTX treatment in different glomerulopathies. In this regard, we describe randomized controlled trials (RCTs) performed in adults, whenever possible. A literature search was performed using clinicaltrials.gov and PubMed.

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Section: Discussionmentioning

confidence: 99%

Rituximab use in adult glomerulopathies and its rationale

et al. 2020

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“…Treatment of GPA generally consists of an induction phase and a maintenance phase 3. Induction is most commonly achieved with a combination of cyclophosphamide and prednisolone.…”

Section: Discussionmentioning

confidence: 99%

Toothache and hearing loss: early symptoms of granulomatosis with polyangiitis (GPA)

2016

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Granulomatosis with polyangiitis is an uncommon condition characterised by vasculitis and associated granuloma formation with a highly specific autoantibody, namely proteinase 3-anti-neutrophil cytoplasmic antibody (ANCA). The respiratory tract and kidneys are the organ systems most often involved. Symptoms can be non-specific, and isolated hearing loss can predate other symptoms by months, leading to lengthy delays in diagnosis and treatment. Left untreated, hearing loss can be irreversible, and therefore early diagnosis is crucial. We present a case study of severe hearing impairment in an attempt to raise awareness of ear involvement as an early feature of this unusual condition.

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“… 5 AAV has multiple clinical manifestations, characterised by leucocytes infiltrating the vessel walls, fibrinoid necrosis and vascular damage with occlusion or aneurysm formation. 6 The severity of AAV varies greatly, but after months to years of non-severe manifestations, patients with non-severe diseases often progress to severe diseases. 7 The most common severe AAV manifestation is glomerulonephritis, which leads to renal failure and alveolar capillaritis causing pulmonary haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…The annual incidence of AAV is about 20 per million inhabitants, and the prevalence is about 100 per million inhabitants 5. AAV has multiple clinical manifestations, characterised by leucocytes infiltrating the vessel walls, fibrinoid necrosis and vascular damage with occlusion or aneurysm formation 6. The severity of AAV varies greatly, but after months to years of non-severe manifestations, patients with non-severe diseases often progress to severe diseases 7.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of alternative glucocorticoids regimens in patients with ANCA-associated vasculitis: a systematic review

et al. 2022

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ObjectiveTo compare the efficacy and safety of alternative glucocorticoids (GCs) regimens as induction therapy for patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis.DesignSystematic review of randomised controlled trials (RCTs).Data sourcesMedline, Embase, Clinicaltrials.gov and Cochrane Central Register of Controlled Trials up to 10 April 2020.Study selection and review methodsRCTs comparing two (or more) different dose regimens of GC in ANCA-associated vasculitis during induction of remission, regardless of other therapies. Pairs of reviewers independently screened records, extracted data and assessed risk of bias. Two reviewers rated certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsOf 3912 records identified, the full texts of two records met the eligibility criteria. Due to the heterogeneity of population and dose regimen of GCs between the two trials, we descriptively presented the two trials and did not combine the results using meta-analysis. Compared with the standard-dose regimen, the reduced-dose regimen of GC may reduce death risk difference (RD): from −1.7% to −2.1%, low certainty), while not increasing end-stage kidney disease (ESKD) (RD: from −1.5% to 0.4%, moderate certainty). The reduced-dose regimen probably has an important reduction in serious infections at 1 year (RD: from −12.8% to −5.9%, moderate certainty). Reduced-dose regimen of GCs probably has trivial or no effect in disease remission, relapse or health-related quality of life (moderate to high certainty).ConclusionsThe reduced-dose regimen of GC may reduce death at the follow-up of 6 months to longer than 1 year and serious infections while not increasing ESKD.PROSPERO registration numberCRD42020179087.

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Update on the treatment of ANCA associated vasculitis

Cited by 17 publications

References 83 publications

Rituximab use in adult glomerulopathies and its rationale

Rituximab use in adult glomerulopathies and its rationale

Toothache and hearing loss: early symptoms of granulomatosis with polyangiitis (GPA)

Comparative efficacy and safety of alternative glucocorticoids regimens in patients with ANCA-associated vasculitis: a systematic review

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