Novel therapies for anti-neutrophil cytoplasmic antibody-associated vasculitis

High-dose corticosteroids in combination with cytotoxic drugs are universal ly accepted as the initial approach in vasculitides that are associated wit h anti-neutrophil cytoplasmic antibodies. Cyclophosphamide is the most effe ctive cytotoxic drug and is used in more severe cases. Because cyclophospha mide has more severe short- and long-term side-effects than methotrexate, m ethotrexate is used in less severe cases. New prospects for the treatment o f vasculitis include novel immunosuppressive agents (e,g. mycophenolate, 15 -deoxyspergualin, and leflunomide), sequential chemotherapy (e.g. cyclophos phamide followed by azathioprine or cyclophosphamide followed by methotrexa te), intravenous immunoglobulin, tumour necrosis factor-a directed therapy, antilymphocyte directed therapy (e.g, antithymocyte globulin or anti CD52/ anti CD4 antibodies), anti-adhesion molecule directed therapy (e.g. anti-CD 18 or intercellular adhesion molecule-1 antisense) or immunoablation using high-dose cytotoxic medication with or without stem cell rescue. Curr Opin Nephrol Hypertens 10:211-217. (C) 2001 Lippincott Williams & Wilkins.