PMID- 36102147
OWN - NLM
STAT- MEDLINE
DCOM- 20221021
LR  - 20221216
IS  - 1744-8409 (Electronic)
IS  - 1744-666X (Linking)
VI  - 18
IP  - 11
DP  - 2022 Nov
TI  - How best to manage relapse and remission in ANCA-associated vasculitis.
PG  - 1135-1143
LID - 10.1080/1744666X.2022.2122954 [doi]
AB  - INTRODUCTION: A two-stage therapeutic approach is now applied as standard-of-care 
      to treat antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAVs): 
      first, glucocorticoids (GCs) combined with cyclophosphamide (CYC) or rituximab 
      (RTX) to induce remission, and then relapse prevention with remission-maintenance 
      therapy. Nonetheless, a substantial risk of relapse persists. AREAS COVERED: The 
      authors provide an overview of the current state of AAV remission-induction after 
      relapse and maintenance therapies, and discuss new strategies recommended to 
      prevent and treat relapses, focusing on granulomatosis with polyangiitis (GPA) 
      and microscopic polyangiitis (MPA). EXPERT OPINION: For remission-induction after 
      GPA or MPA relapse with organ-threatening manifestations, reintroduction or 
      intensification of GCs in combination with CYC or RTX cycle is recommended; we 
      prefer RTX in light of its superior responses obtained in patients with relapsing 
      disease. Rapid tapering of GCs has been shown not to alter AAV evolution while 
      decreasing the risk of serious infections. In contrast, for non-severe, active 
      MPA, we recommend GCs alone as first-line therapy. For patients whose MPA remains 
      uncontrolled by GCs alone, immunosuppressant adjunction can be a GC-sparing 
      option or to counter GC intolerance. Once remission is achieved, we recommend 
      prolonged maintenance therapy with preemptive low-dose (500 mg) RTX infusion 
      biannually.
FAU - Puechal, Xavier
AU  - Puechal X
AUID- ORCID: 0000-0003-3573-9203
AD  - National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin, 
      Assistance Publique-Hopitaux de Paris (APHP) centre, Universite Paris Cite, 
      Paris, France.
AD  - French Vasculitis Study Group, Hopital Cochin, Paris, France.
FAU - Guillevin, Loic
AU  - Guillevin L
AUID- ORCID: 0000-0002-4518-7345
AD  - National Referral Center for Rare Systemic Autoimmune Diseases, Hopital Cochin, 
      Assistance Publique-Hopitaux de Paris (APHP) centre, Universite Paris Cite, 
      Paris, France.
AD  - French Vasculitis Study Group, Hopital Cochin, Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20220914
PL  - England
TA  - Expert Rev Clin Immunol
JT  - Expert review of clinical immunology
JID - 101271248
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Humans
MH  - Rituximab/therapeutic use
MH  - Antibodies, Antineutrophil Cytoplasmic
MH  - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy
MH  - *Microscopic Polyangiitis/drug therapy
MH  - Remission Induction
MH  - Cyclophosphamide/therapeutic use
MH  - Immunosuppressive Agents/therapeutic use
MH  - Recurrence
MH  - Glucocorticoids/therapeutic use
MH  - *Granulomatosis with Polyangiitis/drug therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cyclophosphamide
OT  - granulomatosis with polyangiitis
OT  - induction treatment
OT  - maintenance therapy
OT  - microscopic polyangiitis
OT  - plasma exchange
OT  - prognostic factors
OT  - relapse
OT  - rituximab
EDAT- 2022/09/15 06:00
MHDA- 2022/10/22 06:00
CRDT- 2022/09/14 04:32
PHST- 2022/09/15 06:00 [pubmed]
PHST- 2022/10/22 06:00 [medline]
PHST- 2022/09/14 04:32 [entrez]
AID - 10.1080/1744666X.2022.2122954 [doi]
PST - ppublish
SO  - Expert Rev Clin Immunol. 2022 Nov;18(11):1135-1143. doi: 
      10.1080/1744666X.2022.2122954. Epub 2022 Sep 14.