Treatment strategies for ANCA-associated vasculitides: from standard protocols to future horizons.

IF 3.9 3区 医学 Q2 IMMUNOLOGY Expert Review of Clinical Immunology Pub Date : 2024-07-01 Epub Date: 2024-03-06 DOI:10.1080/1744666X.2024.2326628
Francesco Reggiani, Matteo Stella, Marta Calatroni, Renato Alberto Sinico
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Abstract

Introduction: ANCA-associated vasculitides (AAV), classified into granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis represent a group of disorders characterized by necrotizing vasculitis of small vessels, endothelial injury and tissue damage. The outcomes and prognosis of AAV have undergone significant changes with the introduction of glucocorticoids (GCs) and other immunosuppressants (cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil). The enhanced understanding of pathogenesis has subsequently led to the incorporation into clinical practice of drugs targeting specific therapeutic targets.

Areas covered: After an extensive literature search of Pubmed, Medline, Embase of the most recent evidence, we provide an overview of available treatments, highlighting how newer drugs have integrated into standard protocols. Our review also explores potential new therapeutic targets, including B cell depletion and inhibition, T cell inhibition, complement inhibition, and IL-5 and IgE inhibition.

Expert opinion: There is hope that the new treatment targets currently under study in AAV may enable a faster and more lasting clinical response, ensuring the reduction of possible side effects from therapies. Moreover, numerous aspects necessitate further exploration in the future, such as tailoring of GCs, integration of GCs-sparing agents, efficacy of combination therapy, optimal maintenance therapy, to reduce organ-damage and improve quality of life.

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ANCA相关血管病的治疗策略:从标准方案到未来展望。
简介ANCA相关性血管炎(AAV)分为肉芽肿伴多血管炎、微小多血管炎和嗜酸性肉芽肿伴多血管炎,是一组以小血管坏死性血管炎、内皮损伤和组织损伤为特征的疾病。随着糖皮质激素(GCs)和其他免疫抑制剂(环磷酰胺、硫唑嘌呤、甲氨蝶呤和霉酚酸酯)的引入,AAV 的疗效和预后发生了重大变化。随着对发病机制认识的加深,针对特定治疗靶点的药物也被纳入临床实践:在对 Pubmed、Medline 和 Embase 的最新证据进行广泛的文献检索后,我们对现有的治疗方法进行了概述,重点介绍了较新的药物是如何纳入标准方案的。我们的综述还探讨了潜在的新治疗靶点,包括B细胞耗竭和抑制、T细胞抑制、补体抑制以及IL-5和IgE抑制:目前正在研究的 AAV 新治疗靶点有望更快、更持久地产生临床反应,确保减少疗法可能产生的副作用。此外,未来还有许多方面需要进一步探索,如定制 GCs、整合 GCs 节约型药物、联合疗法的疗效、最佳维持疗法,以减少器官损伤并提高生活质量。
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来源期刊
CiteScore
7.60
自引率
2.30%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Expert Review of Clinical Immunology (ISSN 1744-666X) provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in clinical immunology. Members of the International Editorial Advisory Panel of Expert Review of Clinical Immunology are the forefront of their area of expertise. This panel works with our dedicated editorial team to identify the most important and topical review themes and the corresponding expert(s) most appropriate to provide commentary and analysis. All articles are subject to rigorous peer-review, and the finished reviews provide an essential contribution to decision-making in clinical immunology. Articles focus on the following key areas: • Therapeutic overviews of specific immunologic disorders highlighting optimal therapy and prospects for new medicines • Performance and benefits of newly approved therapeutic agents • New diagnostic approaches • Screening and patient stratification • Pharmacoeconomic studies • New therapeutic indications for existing therapies • Adverse effects, occurrence and reduction • Prospects for medicines in late-stage trials approaching regulatory approval • Novel treatment strategies • Epidemiological studies • Commentary and comparison of treatment guidelines Topics include infection and immunity, inflammation, host defense mechanisms, congenital and acquired immunodeficiencies, anaphylaxis and allergy, systemic immune diseases, organ-specific inflammatory diseases, transplantation immunology, endocrinology and diabetes, cancer immunology, neuroimmunology and hematological diseases.
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