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Vol. 6. Issue 3.
Pages 161-172 (May - June 2010)
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Vol. 6. Issue 3.
Pages 161-172 (May - June 2010)
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Treatment of ANCA-associated systemic vasculitis
Tratamiento de las vasculitis sistémicas asociadas a ANCA
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7695
Iñigo Rúa-Figueroa Fernández de Larrinoa
Corresponding author
, Celia Erausquin Arruabarrena
Servicio de Reumatología, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
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Article information
Abstract

The treatment of systemic vasculitis has undergone important changes in recent years. Cyclophosphamide still plays a crucial role in the induction of remission in severe forms, reducing the mortality. However, its use entails a significant long-term toxicity and the accumulation of damage resulting from a sub-optimal control of the process. Strategies has been developed to limit exposure to the drug and minimize its toxicity, such as using intravenous pulses as an alternative to oral administration and a sequential strategy. Both induce remission in less severe cases and work also for the maintenance of remission; the use of alternative immunosuppressants, such as methotrexate, azathioprine or leflunomide has been advocated. In life-threatening situations, options such as plasmapheresis or intravenous inmunoglobulins are available. Biologic therapies are a promising alternative, but their use must be limited for now to refractory cases.

Keywords:
Vasculitis
ANCA
Treatment
Resumen

El tratamiento de las vasculitis sistémicas ha experimentado cambios sustanciales en los últimos años. La ciclofosfamida sigue teniendo un papel crucial en la induccíon de remisíon en formas severas, reduciendo considerablemente la mortalidad. Sin embargo, su empleo conlleva una importante toxicidad a largo plazo y el acúmulo de morbilidad derivada de un control subóptimo del proceso. Se han desarrollado estrategias para limitar la exposición al fármaco y minimizar su toxicidad, como son el uso de pulsos endovenosos como alternativa a la vía oral y la estrategia secuencial. Tanto para inducir remisión en casos no severos como para el mantenimiento de remisión se preconiza el empleo de inmunosupresores alternativos, como son el metotrexate, la azatioprina o la leflunomide. En determinadas situaciones con compromiso vital puede recurrirse a opciones como la plasmaféresis o las inmunoglobulinas endovenosas. Las terapias biológicas suponen una alternativa prometedora, si bien su empleo actual debe restringirse a los casos refractarios.

Palabras clave:
Vasculitis
ANCA
Tratamiento
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