Therapiedeeskalation bei ANCA-assoziierten Vaskulitiden

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• 作者：S. Schinke ; G. Riemekasten ; Prof. Dr. P. Lamprecht
• 关键词：SchlüsselwörterRemission ; Rezidiv ; Monitoring ; Immunsuppression ; Glukokortikoide
• 刊名：Zeitschrift für Rheumatologie
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：76
• 期：1
• 页码：15-20
• 全文大小：
• 刊物主题：Internal Medicine; Rheumatology;
• 出版者：Springer Medizin
• ISSN：1435-1250
• 卷排序：76

文摘

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) require a differentiated therapeutic approach depending on the degree of organ dysfunction and disease activity. In organ dysfunction and life-threatening AAV cyclophosphamide and rituximab are recommended for the induction of remission. For remission induction with a lack of organ dysfunction and non-life-threatening AAV, methotrexate or mycophenolate mofetil are recommended. For remission maintenance therapy azathioprine or methotrexate are used. In the case of contraindications, intolerance or previous failure of azathioprine and methotrexate treatment, rituximab, leflunomide or mycophenolate mofetil may be used as alternatives. Maintenance therapy is usually continued for at least 2 years. De-escalation of therapy requires continuous clinical monitoring while the glucocorticoid medication and immunosuppressive therapy is tapered; however, every de-escalation of therapy carries a risk of relapse.