Recomendaciones de la Sociedad Argentina de Reumatología para el tratamiento de las vasculitis asociadas a ANCA
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.Citas
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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.
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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.
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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.
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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).
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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.
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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).
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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.
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XL. Jayne DRW, et al. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J Am Soc Nephrol 2017;28(9).
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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.
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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.
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).
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Publicado
2022-11-20
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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 23 de noviembre de 2024];33(Sup5):1 - 49. Disponible en: https://ojs.reumatologia.org.ar/index.php/revistaSAR/article/view/706
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Derechos de autor 2022 A nombre de los autores. Derechos de reproducción: Sociedad Argentina de Reumatología
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