Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis
Limitations of Standard Immunosuppressive Treatment in ANCA-Associated Vasculitis and Lupus Nephritis
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DOI：
10.1159/000368569
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发表时间：
2014-11
影响因子：
--
通讯作者：
V. Tesar;Z. Hruskova
中科院分区：
文献类型：
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作者：
V. Tesar;Z. Hruskova
标准免疫抑制治疗的引入极大地改变了ANCA相关血管炎和狼疮性肾炎患者的结局，将其从具有非常高的短期死亡率的不治之症转变为具有低得多的短期但仍然相对较高的长期发病率/死亡率的慢性衰弱性疾病。部分由于现有治疗的不良事件（即性腺毒性、恶性肿瘤、骨疾病、白内障、糖尿病、血栓栓塞和心血管疾病）造成的损害累积的长期发病率已成为一个主要问题。尽管在ANCA相关血管炎和狼疮性肾炎中，以环磷酰胺为基础的治疗方案已部分被新药物（即分别为利妥昔单抗或麦考酚酯）所取代，但其短期和中期不良事件的发生率可能不会显著降低，我们只能希望新的治疗方法将转化为更好的长期结局，包括更好的长期安全性。
Introduction of the standard immunosuppressive treatment has dramatically changed the outcome of patients with both ANCA-associated vasculitis and lupus nephritis, transforming them from incurable diseases with very high short-term mortality to chronic debilitating diseases with much lower short-term, but still relatively high long-term, morbidity/mortality. Long-term morbidity with damage accumulating partly due to the adverse events of the available treatment (namely gonadal toxicity, malignancy, bone disease, cataracts, diabetes, and thromboembolic and cardiovascular disease) has become a major concern. Although cyclophosphamide-based regimens have been partly replaced by newer agents in both ANCA-associated vasculitis and lupus nephritis (namely rituximab or mycophenolate, respectively) their short-term and medium-term adverse events may not be significantly less frequent and we can only hope that new treatments will translate into better long-term outcomes including better long-term safety.