Adding Azathioprine to Remission‐Induction Glucocorticoids for Eosinophilic Granulomatosis With Polyangiitis (Churg‐Strauss), Microscopic Polyangiitis, or Polyarteritis Nodosa Without Poor Prognosis Factors

Puéchal, Xavier; Pagnoux, Christian; Baron, Gabriel; Quéméneur, T.; Néel, A.; Agard, C.; Lifermann, François; Liozon, É.; Ruivard, M.; Godmer, Pascal; Limal, Nicolas; Mékinian, A.; Papo, Thomas; Ruppert, Anne-Marie; Bourgarit, A.; Bienvenu, Boris; Geffray, Loïck; Saraux, Jean‐Luc; Diot, Élisabeth; Crestani, Bruno; Delbrel, X.; Sailler, L.; Cohen, Pascal; Guern, Véronique Le; Terrier, Benjamin; Groh, Matthieu; Jeunne, Claire Le; Mouthon, Luc; Ravaud, Philippe; Guillevin, Loı̈c

doi:10.1002/art.40205

Cited by 133 publications

(46 citation statements)

References 33 publications

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“…Furthermore, expert opinion and small studies suggest that use of immunosuppressive agents does not substantially affect relapse rates. 14 Considering the inadequate efficacy of OGCs in inducing relapse-free remission and the significant side effect burden associated with both OGCs and other immunosuppressive drugs, there is a pressing need for more effective and tolerable treatment options for EGPA.…”

mentioning

confidence: 99%

Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis

Steinfeld

Bradford

Brown³

et al. 2019

Journal of Allergy and Clinical Immunology

101

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GRAPHICAL ABSTRACT eosinophils BVAS, Birmingham Vasculitis Activity Score; D, day; GC, Glucocorticoids (prednisone/prednisolone); MoA, mechanism of action Eosinophil Mepolizumab MoA for mepolizumab CLINICAL BENEFIT: DEFINITION 1 CLINICAL BENEFIT: DEFINITION 2 87% MEPOLIZUMAB vs 53% PLACEBO Remission (BVAS 0 and ≤4 mg/d GC) or ≥50% reduction in GC dose or relapse-free Remission (BVAS 0 and ≤7.5 mg/d GC) or ≥50% reduction in GC dose or relapse-free 78% MEPOLIZUMAB vs 32% PLACEBO

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mentioning

confidence: 99%

Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis

Steinfeld

Bradford

Brown³

et al. 2019

Journal of Allergy and Clinical Immunology

101

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“…Studien liegen hierzu aber nicht vor, bzw. eine kleinere Studie mit AZA wies keinen Vorteil gegen über eine GC-Monotherapie auf [30].…”

Section: Remissionsinduktion Bei Organbedrohender Und Nicht-organbedrunclassified

Update Therapie der ANCA-assoziierten Vaskulitiden

Holle¹,

Moosig²

2019

Akt Rheumatol

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ZusammenfassungDieser Artikel gibt eine Übersicht über die aktuellen deutschen und europäischen Therapieempfehlungen zu den ANCA-assoziierten Vaskulitiden (AAV) sowie ein Update zu seither publizierten wichtigen Therapiestudien. Nach den deutschen und europäischen Empfehlungen erfolgt die Remissionsinduktion bei GPA/MPA mit organbedrohender Erkrankung mit Glucocorticoiden und Cycloposphamid oder Rituximab, bei nicht organbedrohender Erkrankung mit Glucocorticoiden und Methotrexat (MTX) oder Mycophenolat-Mofetil (MMF). Die kürzlich publizierte MYCYC-Studie unterstützt die Empfehlungen; sie zeigte eine Nicht-Unterlegenheit gegenüber i. v. Cyclosphamid bei GPA/MPA-Patienten mit nicht-organbedrohender und organbedrohender Erkrankung auf. Die remissionserhaltende Therapie soll mit niedrig-dosierten Glucocorticoiden sowie Azathioprin, MTX und Rituximab durchgeführt werden. Rituximab wurde Ende 2018 auf der Basis der MAINRITSAN-Studie als remissionserhaltende Therapie zugelassen und ist damit nun die formal einzige zur Remissionserhaltung zugelassene Therapie. Mehrere Studien zur untersuchten zudem die kurze Anwendung von Glucocorticoiden (z. B. durch additive Therapie mit Avacopan) in der Remissionsinduktion und das komplette Ausschleichen von Glucocorticoiden in der Remissionserhaltung. Die ersten Ergebnisse hierzu sind vielversprechend; Langzeitdaten stehen allerdings aus. Für die sehr viel seltenere EGPA liegen insgesamt deutlich weniger Studiendaten vor. Die Therapie wird jedoch im Wesentlichen nach den gleichen Prinzipien wie bei den anderen AAV durchgeführt. Neuerdings steht, in Deutschland für diese Indikation aber noch nicht zugelassen, eine Biologikatherapie mit dem Anti-IL-5-Antikörper Mepolizumab zur Verfügung.

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“…EGPA remains a subset of AAV that is relatively more difficult to treat, and recent literature has suggested promise with the use of rituximab,, IFN‐α and omalizumab as first‐line or reserve agents in patients with this rarer form of AAV. A recent French multicentric trial, the CHUSPAN study, did not reveal benefit of addition of azathioprine (vs placebo) to corticosteroids for the induction of remission in 95 patients with EGPA, MPA or PAN of lesser severity . The C5a receptor antagonist, avacopan, has recently shown promise as a potential steroid‐replacing therapy in induction regimens of AAV .…”

Section: Anca Vasculitismentioning

confidence: 99%

Vasculitis research: Current trends and future perspectives

et al. 2018

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We discuss recent and prospective research in small and large vessel vasculitis. Large cohorts of Takayasu arteritis (TA) have been recently published from across the world, clarifying our understanding of this uncommon disease. Novel open-ended approaches like large-scale genotyping, proteomics and metabolomics have helped gain novel insights into TA, giant cell arteritis (GCA) and anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Recent advances in the imaging of TA and GCA offer promise for earlier diagnosis and better monitoring of response to therapy. Although two randomized controlled trials of abatacept and tocilizumab failed to meet their primary end-points, successful large-scale studies of abatacept and tocilizumab in GCA hold promise for better disease control. While cyclophosphamide has revolutionized the management of AAV, increasing use of rituximab as an alternative induction regimen, as well as use of novel approaches involving reduced or no corticosteroid use for AAV and alternative agents such as avacopan (a complement 5a receptor antagonist) hold promise for lesser toxic induction regimens in the future. Increasingly, the risk of cardiovascular events and comorbidities such as osteoporosis are being recognized as factors affecting long-term prospects of patients with vasculitis. There is a shift in emphasis to utilize patient-reported outcomes to more accurately gauge the impact of vasculitides and their treatment.

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Adding Azathioprine to Remission‐Induction Glucocorticoids for Eosinophilic Granulomatosis With Polyangiitis (Churg‐Strauss), Microscopic Polyangiitis, or Polyarteritis Nodosa Without Poor Prognosis Factors

Abstract: Addition of AZA to glucocorticoids for the induction of remission of nonsevere SNVs does not improve remission rates, lower relapse risk, spare steroids, or diminish the EGPA asthma/rhinosinusitis exacerbation rate.

Cited by 133 publications

References 33 publications

Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis

Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis

Update Therapie der ANCA-assoziierten Vaskulitiden

Vasculitis research: Current trends and future perspectives

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