7Adverse effects of therapy for ANCA-associated vasculitis
Section snippets
Treatment strategies
Treatment of ANCA-associated vasculitis has an initial phase aimed at inducing remission and a second phase aiming to maintain remission and prevent relapse. Standard induction therapy with prednisolone and cyclophosphamide can induce remission in up to 90% of patients; maintenance therapy limits relapse rates to 18–40% [2]. The European League Against Rheumatism (EULAR) have recently published a series of guidelines on the management of vasculitis, with treatment recommended according to
Thromboembolic complications
The risk of thromboembolic disease is increased during inflammatory disease. Like other chronic inflammatory autoimmune diseases, such as systemic lupus erythematosus (SLE) or inflammatory bowel disease, the risk of deep vein thrombosis or pulmonary embolism is increased in patients with AASV. Studies of patients with AASV suggest an increased incidence of venous thromboembolism (VTE) of 1.8–7.0 out of 100 person-years, compared with 0.3 out of 100 person-years in the equivalent healthy Swedish
Drug reactions and hypersensitivity
At the outset of treatment with immunosuppressives, there are immediate risks related to drug toxicity, some of which can be difficult to distinguish from the effects of active or refractory disease.
Chronic burden of therapy
As patients with AASV increasingly survive the initial months and first year of their disease, they face the long-term effects of damage due to disease and therapy. In this phase, most adverse effects threaten function and quality of life rather than life itself; however, accumulated effects such as increasing risks of cardiovascular and malignant disease can slowly impact mortality in the longer term. One study of accumulated damage in WG reported that 15% of damage items were attributed to
Reducing the burden of therapy
The key to reducing the adverse effects of vasculitis therapy is better understanding of the disease, therefore allowing the use of less toxic therapies. Maintaining expertise in a rare disease is challenging and it is for this reason that a new set of recommendations by EULAR first recommends that patients with small and medium vessel vasculitis be managed in collaboration with centres of expertise [3]. This allows easier distinction between active disease and damage, enables ready access to
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