AB0595 Novel approachs based in current evidence in anca-associated vasculitis with renal involvement treatment

Abstract

BackgroundANCA-associated vasculits (AAV) are a group of multi-system autoinmune diseases characterized by inflamation and necrosis in small and medium vessels.AAV could respond to diferent therapeutics protocols depends on diverse levels of clinical severity and early treatment could improve the outcome of the disease.In spite of recognized efficay of regimens consisting of cyclophosphamide and high-dose corticosteroids to control the AAV,efforts to minimize drugs-related toxicity led to consider targeted therapies.ObjectivesConsidering the currently quality evidence in therapies novely proposed to AAV and the severity of renal disease presentation,we suggest new rational approaches emphasizing targeting B-cells therapy and preventing disease relapseMethodsWe identified the latest quality evidence using methodological search filters,assessed the evidence quality with Cochrane Renal Goup check list and determinated the strenght of recommendations by Levels of Evidence (Oxford Centre for Evidence-based Medicine)ResultsRituximab (RTX), a monoclonal anti-CD 20antibody, has emerged as the biologic agent more using in AAV patients in current publications and unlike latest Guides and Recommendations published,RTX would be recommended in induction and maintenance AAV with renal involvement treatment (Table 1).Table 1AAV Induction TherapyEarly systemic (GF>60 ml'):MTX + GC (Ib,B)Severe generalised (Cr>5.68 mg/dl):CFM IV/PO + MPS (Ia,A)Generalised with contraindication to CFM:RTX + GC (Ib,B)Prophylaxis against Pneumocystis jirovecii(in CFM or RTX therapy):Cotrimoxazol PO (IIb,B)Severe with RPGN: Plasma Exchange-adjuvant therapy (Ia, B)AAV Maintenance TherapyLow-dose GC + AZA up 18 months (IIb,B)Low-dose GC + LF (less safer) (Ib,B)Low-dose GC + MTX with GF >60 ml/'(Ib,B)Avoid use CFM long-term (higher relapse risk) (Ia,A)In GPA:RTX + GC low-dose each 6 months up18 months (Ib, B)AAV RelapseMinor Relapse:increase GC dose (IIb,C)Major Relapse:RTX + GC (Ia,A)Major Relapse with CFM cumulative dose <36 gr:CFM + GC (Ib,B)Plasma Exchange and/or MPS (IIb,C)VAA RefractariaRTX + GC,specially patients whose never recived RTX (II,B)Plasma Exchange in RPGN and/or dialysis-dependen (Ia,B)GF: glomerular filtrate, MTX:metotrexate, GV: glucocorticoids, Cr: creatinine, CFM: ciclophosphamide, IV: intravenous, PO: oral, MPS: metilprednisolone, RTX: rituximab, RPGN: rapidly progressive glomerulonephritis, AZA: azathioprine, LF: leflunomide, GPA: granulomatosis with polyangiitis.ConclusionsCurrent therapeutical protocols for AVV with renal involvement show that emerging therapies like RTX could improve rates of relapses and treatment-related toxicity. Further studies would provide target-therapeutical optionsReferences Vazquez V et al. Clinical practice guideline for ANCA-associated vasculitis with renal involvement. Medicina (Buenos Aires). 2015;75 Suppl 1:1–38Mukhtyar C et al. EULAR recommendations for the management of primary small and medium vesselvasculitis. Ann Rheum Dis 2009;68:310–317.Guillevin L et al. Rituximab versus Azathioprine for ...

Co-occurrence of Three Systemic Diseases: ANCA-associated Vasculitis, Sjögren's syndrome and Sarcoidosis

“…Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic disease characterized as the inflammation of small vessels in various organs ( 1 ). Sjögren's syndrome (SjS) is also a systemic disease characterized by symptoms of dry eyes and dry mouth and sometimes involves other organs, including the lung, kidney, and skin ( 2 ).…”