Liječenje vaskulitisa povezanih s antineutrofilnim citoplazmatskim protutijelima

Scientific paper - Original scientific paper

• Title (english): Treatment of anti-neutrophil cytoplasmic antibody related vasculitis
• Author: Krešimir Galešić
• Author: Ivica Horvatić
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

ANCA-associated vasculitides are a well-known clinico-pathological group of systemic diseases comprising microscopic poliangiitis, granulomatosis with poliangiitis and eosinophilic granulomatosis with poliangiitis. This article shows contemporary treatment of this diseases with extensive literature review. Stepwise treatment of ANCA-associated vasculitides is divided into induction therapy and remission maintenance therapy. Standard induction therapy is a combination of glucocorticoids and cyclophosphamide, and in maintenance therapy, combination of low-dose glucocorticoids and azathioprine or methotrexate is used. Leading rheumatology and nephrology associations developed treatment guidelines. Since ANCA-associated vasculitides are relatively rare diseases, there are only few randomized controlled studies to provide high level of evidence and treatment recommendations. Most patients achieve remission, but relapses often occur. The main treatment considerations, apart from frequently relapsing disease, are disease refractory to treatment and potentially harmful effects of immunosuppressants, especially cyclophosphamide. Future studies are needed to determine the effects of less toxic immunosuppressants, mainly biological agents.

Abstract (croatian)

Vaskulitisi vezani uz ANCA dobro su poznata kliničko-patološka skupina sustavnih bolesti koja obuhvaća mikroskopski poliangiitis, granulomatozni poliangiitis i eozinofilni granulomatozni poliangiitis. U ovome preglednom članku prikazano je suvremeno liječenje ovih bolesti s opširnim osvrtom na literaturne podatke. Liječenje ovih bolesti stupnjevito je i dijeli se na indukcijsko liječenje te terapiju održavanja. Standardno indukcijsko liječenje čini kombinacija glukokortikoida i ciklofosfamida, a terapiju održavanja kombinacija niske doze glukokortikoida i azatioprina ili metotreksata. Vodeća svjetska reumatološka i nefrološka društva imaju jasne smjernice za liječenje tih bolesti. S obzirom na to da je riječ o relativno rijetkim bolestima, malo je randomiziranih kliničkih istraživanja te posljedično tomu i visokih razina dokaza i preporuke glede liječenja. U većine bolesnika postigne se remisija bolesti, ali su relapsi česti. Osnovni problem u liječenju osim često relabirajuće bolesti jesu i refrakterni oblici bolesti te potencijalni štetni učinci liječenja, posebice ciklofosfamida. Buduća istraživanja bit će usmjerena na traženje manje toksičnih imunosupresiva, ponajprije bioloških lijekova.

• Keywords (english): Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Cyclophosphamide/therapeutic use; Drug Therapy, Combination; Glucocorticoids/therapeutic use; Humans; Immunosuppressive Agents/administration & dosage; Immunosuppressive Agents/therapeutic use; Methotrexate/therapeutic use; Recurrence; Remission Induction
• Language: croatian
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 136, no. 7-8, pp. 232-237
• p-ISSN: 0024-3477
• URN:NBN: urn:nbn:hr:105:694546
• Publication: 2014-07
• Document URL: http://lijecnicki-vjesnik.hlz.hr/lijecnicki-vjesnik/lijecenje-vaskulitisa-povezanih-s-antineutrofilnim-citoplazmatskim-protutijelima/
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:27:06