The evolving treatment of ANCA-associated vasculitides.

Prevention of organ damage and maintenance of long-term remission are the principal goals for treatment of ANCA-associated vasculitides. This can be accomplished by early diagnosis and swift initiation of remission-inducing agents. Outcome has improved but relapses and glucocorticoid- and cyclophosphamide-related toxicity are still major concerns. For remission induction in generalized disease a combination of glucocorticoids and cyclophosphamide or rituximab is used. Rituximab is suitable especially for younger patients with fertility concerns and when cyclophosphamide avoidance otherwise is desirable. In the treatment of relapses and refractory disease, rituximab has proved effective. As maintenance treatment rituximab prevents relapses more effectively than azathioprine.