ANCA-associated vasculitis: mission incomplete

• Published in: Annals of the rheumatic diseases Vol. 77; no. 2; p. e8
• Main Authors: Moiseev, Sergey V, Novikov, Pavel I, Smitienko, Ilya
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2018
• Subjects: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Anticoagulants; Antineutrophil cytoplasmic antibodies; Arteriosclerosis; Cardiovascular diseases; Clinical medicine; Clinical trials; Corticosteroids; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Dyslipidemia; Health risk assessment; Humans; Kidney diseases; Medical prognosis; Meta-analysis; Monoclonal antibodies; Mortality; Neutropenia; Risk factors; Rituximab; Studies; Thromboembolism; Vasculitis; Europe; Russia; Granulomatosis with polyangiitis; Systemic vasculitis; Epidemiology
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2017-211773

[...]it can cause serious infections, late-onset neutropenia and hypogammaglobulinaemia. [...]in the randomised controlled trials retreatment with rituximab was not associated with a lower rate of adverse events compared with that in the other arms. Patients with AAV have an increased risk of cardiovascular events that may be determined by highly prevalent traditional risk factors, such as hypertension, dyslipidaemia and type 2 diabetes, vasculitis itself and/or atherogenic effects of corticosteroids. [...]in addition to vigorous risk factors, modification of steroid-sparing strategies may confer protective effects against atherosclerotic cardiovascular disease. In a large cohort of patients with AAV (n=377), we were unable to establish sufficiently strong predictors of venous thromboembolic events, except a short time after diagnosis, that would justify thromboprophylaxis with oral anticoagulants. [...]it is currently unknown how to use this double-edged sword in real-life clinical practice.