Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de las vasculitis asociadas a ANCA

  • Alejandra Babini Sociedad Argentina de Reumatología
  • Sebastián Magri Sociedad Argentina de Reumatología
  • Alex Kostianovsky Sociedad Argentina de Reumatología
  • Claudi Pena Sociedad Argentina de Reumatología
  • Marina Scolnik Sociedad Argentina de Reumatología
  • Natalia Zamora Sociedad Argentina de Reumatología
  • María Laura Acosta Felquer Sociedad Argentina de Reumatología
  • Leandro Carlevaris Sociedad Argentina de Reumatología
  • Santiago Scarafia Sociedad Argentina de Reumatología
  • Facundo Vergara Sociedad Argentina de Reumatología
  • Guillermo Bartel Sociedad Argentina de Reumatología
  • Alejandro Brigante Sociedad Argentina de Reumatología
  • Oscar Andrés Caicedo Correa Sociedad Argentina de Reumatología
  • Ignacio Gandino Sociedad Argentina de Reumatología
  • Hugo Laborde Sociedad Argentina de Reumatología
  • Nicolás Lloves Schenone Sociedad Argentina de Reumatología
  • Alberto Orden Sociedad Argentina de Reumatología
  • Nicolás Pérez Sociedad Argentina de Reumatología
  • Valeria Scaglioni Sociedad Argentina de Reumatología
Palabras clave: vasculitis ANCA, vasculitis, granulomatosis con poliangitis, poliangitis microscópica, granulomatosis eosinofílica con poliangitis, ANCA

Resumen

Las vasculitis asociadas a ANCA representan un grupo de enfermedades autoinmunes, multisistémicas, que afectan principalmente a los vasos de pequeño calibre, pudiendo comprometer el tracto respiratorio superior e inferior, el aparato otorrinolaringológico, riñón y piel, aunque eventualmente cualquier órgano puede estar involucrado. Son enfermedades con potencial y severo compromiso de órganos y elevada morbimortalidad. El objetivo de estas guías fue desarrollar las primeras recomendaciones argentinas para su tratamiento, basadas en la revisión de la literatura mediante metodología GRADE. Un panel de expertos en vasculitis elaboró las preguntas en formato PICO (población, intervención, comparador y outcomes), y luego un panel de expertos en metodología efectuó la revisión de la bibliografía con la extracción de la evidencia para cada una de las preguntas. Se realizó un focus group de pacientes para conocer sus preferencias y experiencias. Finalmente, con la información recabada, el panel de expertos en vasculitis procedió a la votación de las recomendaciones que a continuación se presentan.

Biografía del autor/a

Alejandra Babini, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de confección de preguntas PICO, Panel de expertos
Sebastián Magri, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de confección de preguntas PICO, Panel de expertos, Redacción de las recomendaciones
Alex Kostianovsky, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de confección de preguntas PICO, Panel de expertos, Redacción de las recomendaciones
Claudi Pena, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de confección de preguntas PICO, Panel de expertos, Revisora
Marina Scolnik, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de confección de preguntas PICO, Panel de expertos, Redacción de las recomendaciones
Natalia Zamora, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de metodología GRADE
María Laura Acosta Felquer, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de metodología GRADE
Leandro Carlevaris, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de metodología GRADE
Santiago Scarafia , Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de metodología GRADE
Facundo Vergara, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Grupo de metodología GRADE
Guillermo Bartel, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Alejandro Brigante, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Oscar Andrés Caicedo Correa, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Ignacio Gandino, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Hugo Laborde, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Nicolás Lloves Schenone, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Alberto Orden, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Nicolás Pérez, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos
Valeria Scaglioni, Sociedad Argentina de Reumatología
Sociedad Argentina de Reumatología, Panel de expertos

Citas

I. Jennette JC, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013;65(1):1-11. doi: 10.1002/art.37715.
II. Kronbichler A, Lee KH, Denicolò S, Choi D, Lee H, Ahn D, et al. Immunopathogenesis of ANCA-associated vasculitis. Int J Mol Sci 2020;21(19):7319.
III. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016 Dec 5;5(1).
IV. Review Manager (RevMan) Computer program. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 Internet. Citado: 22/04/22. Disponible en: https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman.
V. GRADEpro GDT: GRADEpro Guideline Development Tool. Software. McMaster University, 2015 (developed by Evidence Prime, Inc.) Internet. Disponible en: https://www.gradepro.org/product.
VI. Zoom software. Disponible en: https://zoom.us/.
VII. Adu D, Pall A, Luqmani RA, Richards NT, Howie AJ, Emery P, et al. Controlled trial of pulse versus continuous prednisolone and cyclophosphamide in the treatment of systemic vasculitis. QJM Mon J Assoc Physicians 1997;90(6):401-9.
VIII. Huang L, Zhong Y, Ooi JD, Zhou Y-O, Zuo X, Luo H, et al. The effect of pulse methylprednisolone induction therapy in Chinese patients with dialysis-dependent MPO-ANCA associated vasculitis. Int Immunopharmacol 2019;76:105883.
IX. Walsh M, Merkel PA, Peh C-A, Szpirt WM, Puéchal X, Fujimoto S, et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med 2020;382(7):622-31.
X. Novack SN, Pearson CM. Cyclophosphamide therapy in Wegener’s granulomatosis. N Engl J Med 1971;284(17):938-42.
XI. Guillevin L, Cordier JF, Lhote F, Cohen P, Jarrousse B, Royer I, et al. A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener’s granulomatosis. Arthritis Rheum Dic1997;40(12):2187-98.
XII. Hubitz M, et al. Intravenous pulse administration of cyclophosphamide versus daily oral treatment in patients with antineutrophil cytoplasmic antibody-associated vasculitis and renal involvement: a prospective, randomized study. Arthritis Rheum 1998;41(10):1835-44. doi: doi: 10.1002/1529-0131(199810)41:10<1835::AID-ART16>3.0.CO;2-Q.
XIII. de Groot K, Harper L, Jayne DRW, Flores Suarez LF, Gregorini G, Gross WL, et al. Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med 2009;150(10):670-80.
XIV. Harper L, Morgan MD, Walsh M, Hoglund P, Westman K, Flossmann O, et al. Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis 2012;71(6):955-60.
XV. Jones RB, Tervaert JWC, Hauser T, Luqmani R, Morgan MD, Peh CA, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 15 de julio de 2010;363(3):211-20.
XVI. Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 2010;363(3):221-32.
XVII. van Daalen EE, et al. Effect of rituximab on malignancy risk in patients with ANCA-associated vasculitis. Ann Rheum Dis 2017;76(6). doi: 10.1136/annrheumdis-2016-209925.
XVIII. Hoffman GS, Leavitt RY, Kerr GS, Fauci AS. The treatment of Wegener’s granulomatosis with glucocorticoids and methotrexate. Arthritis Rheum 1992;35(11):1322-9.
XIX. Sneller MC, Hoffman GS, Talar-Williams C, Kerr GS, Hallahan CW, Fauci AS. An analysis of forty-two Wegener’s granulomatosis patients treated with methotrexate and prednisone. Arthritis Rheum 1995;38(5):608-13.
XX. Stone JH, Tun W, Hellman DB. Treatment of non-life threatening Wegener’s granulomatosis with methotrexate and daily prednisone as the initial therapy of choice. J Rheumatol 1999;26(5):1134-9.
XXI. Langford CA et al. Use of methotrexate and glucocorticoids in the treatment of Wegener’s granulomatosis. Long-term renal outcome in patients with glomerulonephritis. Arthritis Rheum 2000;43(8).
XXII. Faurschou M, Westman K, Rasmussen N, de Groot K, Flossmann O, Höglund P, et al. Brief Report: long-term outcome of a randomized clinical trial comparing methotrexate to cyclophosphamide for remission induction in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 2012;64(10):3472-7.
XXIII. Hu W, Liu C, Xie H, Chen H, Liu Z, Li L. Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant 2008;23(4):1307-12.
XXIV. Gg S, Yh L. Comparative efficacy and safety of mycophenolate mofetil versus cyclophosphamide in patients with active antineutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis of randomized trials. Z Rheumatol 2021;80(5).
XXV. Bones RB, et al. Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis. A randomised, non-inferiority trial. Ann Rheum Dis 2019;78(3).
XXVI. Tuin J, Stassen PM, Bogdan DI, Broekroelofs J, van Paassen P, Cohen Tervaert JW, et al. Mycophenolate mofetil versus cyclophosphamide for the induction of remission in nonlife-threatening relapses of antineutrophil cytoplasmic antibody-associated vasculitis: randomized, controlled trial. Clin J Am Soc Nephrol 2019;14(7):1021-8.
XXVII. Klemmer PJ, et al. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am J Kidney Dis 2003;42(6).
XXVIII. Levy JB, Hammad T, Coulthart A, Dougan T, Pusey CD. Clinical features and outcome of patients with both ANCA and anti-GBM antibodies. Kidney Int 2004;66(4):1535-40.
XXIX. Levy JB, et al. Long-term outcome of anti-glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression. Ann Intern Med 2001;134(11).
XXX. Cole E, Cattran D, Magil A, Greenwood C, Churchill D, Sutton D, et al. A prospective randomized trial of plasma exchange as additive therapy in idiopathic crescentic glomerulonephritis. The Canadian Apheresis Study Group. Am J Kidney Dis Off J Natl Kidney Found 1992;20(3):261-9.
XXXI. Jayne DRW, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol 2007;18(7):2180-8.
XXXII. Szpirt WM, Heaf JG, Petersen J. Plasma exchange for induction and cyclosporine A for maintenance of remission in Wegener’s granulomatosis--a clinical randomized controlled trial. Nephrol Dial Transplant 2011;26(1):206-13.
XXXIII. Walsh M, et al. The effects of plasma exchange and reduced-dose glucocorticoids during remission-induction for treatment of severe ANCA-associated vasculitis. Abstract. Arthritis Rheumatol 2018;70 (suppl 9).
XXXIV. de Joode AAE, et al. Plasmapheresis rescue therapy in progressive systemic ANCA-associated vasculitis: single-center results of stepwise escalation of immunosuppression. J Clin Apher 2014;29(5).
XXXV. McAdoo SP, Medjeral-Thomas N, Gopaluni S, Tanna A, Mansfield N, Galliford J, et al. Long-term follow-up of a combined rituximab and cyclophosphamide regimen in renal anti-neutrophil cytoplasm antibody-associated vasculitis. Nephrol Dial Transplant 2019;34(1):63-73.
XXXVI. Geetha D, Hruskova Z, Segelmark M, Hogan J, Morgan MD, Cavero T, et al. Rituximab for treatment of severe renal disease in ANCA associated vasculitis. J Nephrol 2016;29(2):195-201.
XXXVII. Rayne DR, et al. Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. QJM 2000;93(7).
XXXVIII. Kivity S, Katz U, Daniel N, Nussinovitch U, Papageorgiou N, Shoenfeld Y. Evidence for the use of intravenous immunoglobulins. A review of the literature. Clin Rev Allergy Immunol 2010;38(2):201-69.
XXXIX. Fortin PM, et al. Intravenous immunoglobulin as adjuvant therapy for Wegener’s granulomatosis. Cochrane Database 2009;(3).
XL. Jayne DRW, et al. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J Am Soc Nephrol 2017;28(9).
XLI. Jayne DRW, Merkel PA, Schall TJ, Bekker P. Avacopan for the treatment of ANCA-associated Vasculitis. N Engl J Med de 2021;384(7):599-609.
XLII. Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, Cohen P, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med 2014;371(19):1771-80.
XLIII. Terrier B, Pagnoux C, Perrodeau É, Karras A, Khouatra C, Aumaître O, et al. Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides. Ann Rheum Dis 2018;77(8):1150-6.
XLIV. Smith RM, Jones RB, Specks U, Bond S, Nodale M, Aljayyousi R, et al. Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis. Ann Rheum Dis 2020;79(9):1243-9.
XLV. Talar-Williams C, et al. Cyclophosphamide-induced cystitis and bladder cancer in patients with Wegener granulomatosis. Ann Intern Med 1996;124(5).
XLVI. Knight A, Askling J, Granath F, Sparen P, Ekbom A. Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide. Ann Rheum Dis 2004;63(10):1307-11.
XLVII. Jayne D, Rasmussen N, Andrassy K, Bacon P, Tervaert JWC, Dadoniené J, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med 2003;349(1):36-44.
XLVIII. Slot MC, Tervaert JWC, Boomsma MM, Stegeman CA. Positive classic antineutrol cytoplasmic antibody (C-ANCA) titer at switch to azathioprine therapy associated with relapse in proteinase 3-related vasculitis. Arthritis Rheum 2004;51(2):269-73.
XLIX. 59. Langford CA, Talar-Williams C, Barron KS, Sneller MC. Use of a cyclophosphamide-induction methotrexate-maintenance regimen for the treatment of Wegener’s granulomatosis: extended follow-up and rate of relapse. Am J Med 2003;114(6):463-9.
L. Pagnoux C, Mahr A, Hamidou MA, Boffa J-J, Ruivard M, Ducroix J-P, et al. Azathioprine or methotrexate maintenance for ANCA-associated vasculitis. N Engl J Med 2008;359(26):2790-803.
LI. Puéchal X, Pagnoux C, Perrodeau É, Hamidou M, Boffa J-J, Kyndt X, et al. Long-term outcomes among participants in the WEGENT trial of remission-maintenance therapy for granulomatosis with polyangiitis (Wegener’s) or microscopic polyangiitis. Arthritis Rheumatol Hoboken NJ 2016;68(3):690-701.
LII. Hiemstra TF, Walsh M, Mahr A, Savage CO, de Groot K, Harper L, et al. Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody–associated vasculitis: a randomized controlled trial. JAMA 2010;304(21):2381-8.
LIII. Metzler C, Miehle N, Manger K, Iking-Konert C, de Groot K, Hellmich B, et al. Elevated relapse rate under oral methotrexate versus leflunomide for maintenance of remission in Wegener’s granulomatosis. Rheumatol Oxf Engl 2007;46(7):1087-91.
LIV. Yates M, Watts RA, Bajema IM, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis Annals of the Rheumatic Diseases 2016;75:1583-1594.
LV. Ntatsaki E, Carruthers D, Chakravarty K, D’Cruz D, Harper L, Jayne D, et al. BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis. Rheumatol Oxf Engl 2014;53(12):2306-9.
LVI. Mendel A, Ennis D, Go E, Bakowsky V, Baldwin C, Benseler SM, et al. CanVasc Consensus Recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis: 2020 Update. J Rheumatol 2021;48(4):555-66.
LVII. de Souza AWS. Recommendations of the Brazilian Society of Rheumatology for the induction therapy of ANCA-associated vasculitis. Rev Bras Reumatol Eng Ed 2017;57(suppl2):484-496.
LVIII. Karras A, Pagnoux C, Haubitz M, Groot K de, Puechal X, Tervaert JWC, et al. Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis. Ann Rheum Dis 2017;76(10):1662-8.
LIX. Springer J, Nutter B, Langford CA, Hoffman GS, Villa-Forte A. Granulomatosis with polyangiitis (Wegener’s): impact of maintenance therapy duration. Medicine (Baltimore) 2014;93(2):82-90.
LX. Puéchal X, Terrier B, Ravaud P, Mouthon L, Guillevin L; French Vasculitis Study Group. Long-term rituximab use to maintain remission of antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med 2020 Aug 4;173(3):179-187. doi: 10.7326/M19-3827.
LXI. Tanaka H, Yamaguchi M, Katsuno T, Sugiyama H, Iwagaitsu S, Nobata H, et al. Association between sinusitis and relapse and changes in the myeloperoxidase antineutrophil cytoplasmic antibody in microscopic polyangiitis. PLoS ONE 2020;15(12):e0243572.
LXII. Samson M, Puéchal X, Devilliers H, Ribi C, Cohen P, Stern M, et al. Long-term outcomes of 118 patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) enrolled in two prospective trials. J Autoimmun 2013;43:60-9.
LXIII. Puéchal X, Pagnoux C, Baron G, Quémeneur T, Néel A, Agard C, et al. Adding azathioprine to remission-induction glucocorticoids for eosinophilic granulomatosis with polyangiitis (Churg-Strauss), microscopic polyangiitis, or polyarteritis nodosa without poor prognosis factors. A randomized, controlled trial. Arthritis Rheumatol 2017;69(11):2175-86.
LXIV. Metzler C, Hellmich B, Gause A, Gross WL, de Groot K. Churg Strauss syndrome successful induction of remission with methotrexate and unexpected high cardiac and pulmonary relapse ratio during maintenance treatment. Clin Exp Rheumatol 2004;22(6 Suppl 36):S52-61.
LXV. Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Med 2015;26(7):545-53.
LXVI. Doubelt I, Pulenzas N, Carette S, Pagnoux C, Canadian Vasculitis Network (CanVasc). Efficacy of conventional immunosuppressants in relapsing or refractory eosinophilic granulomatosis with polyangiitis: evidence from a Canadian single-centre cohort. Clin Exp Rheumatol 2020;38 Suppl 124(2):171-5.
LXVII. Ribi C, Cohen P, Pagnoux C, Mahr A, Arène J-P, Lauque D, et al. Treatment of Churg-Strauss syndrome without poor-prognosis factors: a multicenter, prospective, randomized, open-label study of seventy-two patients. Arthritis Rheum 2008;58(2):586-94.
LXVIII. Wechsler ME, et al. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med 2017;376(20):1921-1932.
LXIX. Cohen P, Pagnoux C, Mahr A, Arène J-P, Mouthon L, Le Guern V, et al. Churg-Strauss syndrome with poor-prognosis factors. A prospective multicenter trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in forty-eight patients. Arthritis Rheum de 2007;57(4):686-93.
LXX. Thiel J, Troilo A, Salzer U, Schleyer T, Halmschlag K, Rizzi M, et al. Rituximab as induction therapy in eosinophilic granulomatosis with polyangiitis refractory to conventional immunosuppressive treatment. A 36-month follow-up analysis. J Allergy Clin Immunol Pract 2017;5(6):1556-63.
LXXI. Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry M-J, Amudala N, et al. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Ann Rheum Dis 2016;75(2):396-401.
LXXII. Teixeira V, Mohammad AJ, Jones RB, Smith R, Jayne D. Efficacy and safety of rituximab in the treatment of eosinophilic granulomatosis with polyangiitis. RMD Open 2019;5(1):e000905.
LXXIII. Guillevin L, Lhote F, Cohen P, Jarrousse B, Lortholary O, Généreau T, et al. Corticosteroids plus pulse cyclophosphamide and plasma exchanges versus corticosteroids plus pulse cyclophosphamide alone in the treatment of polyarteritis nodosa and Churg-Strauss syndrome patients with factors predicting poor prognosis. A prospective, randomized trial in sixty-two patients. Arthritis Rheum 1995;38(11):1638-45.
LXXIV. Maritati F, Alberici F, Oliva E, Urban ML, Palmisano A, Santarsia F, et al. Methotrexate versus cyclophosphamide for remission maintenance in ANCA-associated vasculitis. A randomised trial. PloS One 2017;12(10):e0185880.
LXXV. Celebi-Sozener Z, Gorgulu B, Mungan D, Sin BA, Misirligil Z, Aydin O, et al. Omalizumab in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA): single-center experience in 18 cases. World Allergy Organ J 2018;11(1):39.
LXXVI. Detoraki A, Tremante E, Poto R, Morelli E, Quaremba G, Granata F, et al. Real-life evidence of low-dose mepolizumab efficacy in EGPA: a case series. Respir Res 2021;22(1):185.
LXXVII. Jachiet M, Samson M, Cottin V, Kahn J-E, Le Guenno G, Bonniaud P, et al. Anti-IgE monoclonal antibody (omalizumab) in refractory and relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss): data on seventeen patients. Arthritis Rheumatol Hoboken NJ 2016;68(9):2274-82.
Publicado
2022-11-20
Cómo citar
1.
Babini A, Magri S, Kostianovsky A, Pena C, Scolnik M, Zamora N, Acosta Felquer ML, Carlevaris L, Scarafia S, Vergara F, Bartel G, Brigante A, Caicedo Correa OA, Gandino I, Laborde H, Lloves Schenone N, Orden A, Pérez N, Scaglioni V. Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de las vasculitis asociadas a ANCA. Rev. Argent. Reumatol. [Internet]. 20 de noviembre de 2022 [citado 7 de diciembre de 2022];33(Sup5):1 - 49. Disponible en: https://ojs.reumatologia.org.ar/index.php/revistaSAR/article/view/706