如何治疗ANCA相关血管炎:来自2016年EULAR/ERA - EDTA建议的实用信息

J. Sznajd, C. Mukhtyar
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引用次数: 6

摘要

欧洲抗风湿病联盟(EULAR)与欧洲肾脏协会-欧洲透析和移植协会最近发布了2009年EULAR建议的更新,重点关注抗中性粒细胞细胞质抗体(ANCA)相关血管增生(AAV)的管理。在这篇文章中,我们讨论了从这些建议中得出的临床实践的以下关键信息:1)如果可能的话,应该进行活检以确认新的诊断或复发;2)糖皮质激素治疗是治疗AAV极其重要的辅助手段,但也是大多数不良反应的原因;剂量应在3至5个月时逐渐减少至7.5至10mg /d;3)环磷酰胺或利妥昔单抗是诱导缓解的主要药物;4)重发患者应与新发患者一样治疗,但既往使用环磷酰胺后复发的患者首选利妥昔单抗;5)轻微复发不应单独使用糖皮质激素治疗,应考虑改变免疫抑制方案;6)利妥昔单抗不仅可用于缓解诱导,也可用于维持;7)维持治疗应持续至少2年,之后可考虑逐渐减量;8)虽然ANCA对诊断非常有用,而且ANCA水平升高似乎与复发有关,但连续监测不应指导治疗决策;9)对AAV患者的监测应全面,采用结构化的评估工具,监测与血管炎相关的影响以及治疗;10)管理应在专家中心或与专家中心一起进行;11)患者应参与决策,并有机会获得教育资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How to treat ANCA‑associated vasculitis: practical messages from 2016 EULAR/ERA‑EDTA recommendations.
The European League against Rheumatism (EULAR) with the European Renal Association - European Dialysis and Transplant Association recently published an update of 2009 EULAR recommendations with a focus on the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). In this article, we discuss the following key messages for clinical practice derived from these recommendations: 1) biopsy should be performed if possible to confirm new diagnosis or relapse; 2) glucocorticoid therapy is an extremely important adjunct to the management of AAV, but it is also responsible for the majority of adverse effects; the dose should be tapered to 7.5 to 10 mg/d at 3 to 5 months; 3) cyclophosphamide or rituximab are the mainstay of remission induction; 4) patients with major relapse should be treated like those with new disease, but rituximab is the preferred option in those patients who relapse after prior cyclophosphamide; 5) minor relapse should not be treated with glucocorticoid alone, and a change in immunosuppressive regimen should be considered; 6) rituximab can be used not only for remission induction but also for maintenance; 7) maintenance therapy should continue for at least 2 years, after which gradual taper could be considered; 8) while ANCA are extremely useful for diagnosis and rising ANCA levels seem to be associated with relapse, serial monitoring should not guide treatment decisions; 9) monitoring of AAV patients should be holistic with a structured assessment tool and monitoring for effects related to the vasculitis as well as treatment; 10) management should be either at or in conjunction with an expert center; and 11) patients should be involved in decision making and have access to educational resources.
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