Immunomodulatory drugs for intensive induction therapy for ANCA-associated vasculitides

Yates, 2016

Patients with organ- or life-threatening features of ANCA-associated vasculitides usually require an immunomodulatory drug in addition to systemic corticosteroids for their intensive induction therapy. Commonly, cyclophosphamide or rituximab are chosen as corticosteroid-sparing drugs. If cyclophosphamide is indicated for inducing remission in ANCA-associated vasculitides, some common regimens includede Groot, 2009:

cyclophosphamide 2 mg/kg up to 200 mg orally, daily for 6 to 12 months cyclophosphamide cyclophosphamide cyclophosphamide

OR

cyclophosphamide 600 mg/m2 intravenously, monthly for 6 to 12 months cyclophosphamide cyclophosphamide cyclophosphamide

OR

cyclophosphamide 15 mg/kg intravenously, as a single dose; repeat fortnightly for 2 further doses, then repeat every 3 weeks thereafter for 6 to 12 months. cyclophosphamide cyclophosphamide cyclophosphamide

For additional considerations about the use of cyclophosphamide, see Specific considerations for use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

If rituximab is indicated for inducing remission in ANCA-associated vasculitides, some common regimens include:

rituximab 375 mg/m2 intravenously, weekly for 4 weeks rituximab rituximab rituximab

OR

rituximab 1 g intravenously, as a single dose; repeat dose after 2 weeks. rituximab rituximab rituximab

For additional considerations about the use of rituximab, see Specific considerations for use of biological or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).

Occasionally other immunomodulatory drugs (eg methotrexate, mycophenolate mofetil) may be used for induction therapy in less-severe ANCA-associated vasculitides.