From the Guidelines
Azathioprine should be used as an additional medication for maintenance therapy in conjunction with Rituximab and Prednisone in ANCA vasculitis with pulmonary hemorrhage.
Maintenance Therapy
- The choice of immunosuppressive agent for maintenance therapy should be based on the individual's risk of relapse and the drug used for maintenance 1.
- Azathioprine is a recommended option for maintenance therapy, with a suggested dose of 1.5-2 mg/kg/d at complete remission, until 1 year after diagnosis, then decreased by 25 mg every 3 months 1.
- Glucocorticoids, such as prednisone, should also be continued at 5-7.5 mg/d for 2 years and then slowly reduced by 1 mg every 2 months 1.
Considerations
- The evidence for the minimum duration of maintenance therapy is weak, but longer maintenance reduces the relapse rate, although it may be associated with more adverse events 1.
- The risk of relapse should be considered when choosing the immunosuppressive agent and duration of maintenance therapy, with factors such as MPO-ANCA, and cardiovascular or lung involvement influencing this decision 1.
- Rituximab has been shown to be effective in achieving remission, but the role of maintenance therapy after rituximab-induced remission, particularly in MPO-ANCA patients, is still debated 1.
- Azathioprine has been tested in clinical trials and is a recommended option for maintenance therapy, while the role of low-dose prednisone for maintaining remission has not been rigorously tested and cannot be universally recommended 1.
From the Research
Maintenance Therapy for ANCA Vasculitis with Pulmonary Hemorrhage
In conjunction with Rituximab and Prednisone, the following medications can be considered for maintenance therapy:
- Azathioprine (AZA) 2, 3, 4
- Cyclophosphamide (CYC) is not typically used for maintenance therapy, but rather for remission induction 5, 3
- There is limited evidence to support the use of other medications for maintenance therapy in ANCA vasculitis with pulmonary hemorrhage
Key Considerations
- Rituximab has been shown to be effective for remission induction and maintenance in ANCA-associated vasculitis 2, 3, 4
- The choice of maintenance therapy should be individualized based on patient factors, such as disease severity and history of relapses 2, 4
- Close monitoring for relapses and adverse events is necessary when using maintenance therapy in ANCA vasculitis with pulmonary hemorrhage 2, 4, 6