Holle Julia U, Moosig Frank
Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, 24534, Neumünster, Deutschland.
Z Rheumatol. 2021 May;80(4):314-321. doi: 10.1007/s00393-021-00974-9. Epub 2021 Mar 11.
Glucocorticoids (GC) still represent an essential pillar of treatment in the phase of remission induction of vasculitides, which are often organ or life-threatening; however, they entail a significant potential for side effects. In the phase of remission maintenance prednisolone should be reduced to 7.5 mg/day or less. Whether a discontinuation can alway be achieved for any form of vasculitis without increasing relapse rates, is unclear. By the use of biologics, e.g. tocilizumab in giant cell arteritis (GCA), a fast tapering and discontinuation of GC seems to be more easily achievable compared to using a GC monotherapy regimen. Avacopan could in the future be an efficient agent to spare GC in the phase of remission induction in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), e.g. granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Mepolizumab is a promising option to reduce the use of GC in eosinophilic granulomatosis with polyangiitis (EGPA).
糖皮质激素（GC）仍然是血管炎缓解诱导期治疗的重要支柱，血管炎通常会危及器官或生命；然而，它们具有显著的副作用风险。在缓解维持期，泼尼松龙应减至7.5毫克/天或更低。对于任何形式的血管炎，是否总能在不增加复发率的情况下实现停药尚不清楚。通过使用生物制剂，例如在巨细胞动脉炎（GCA）中使用托珠单抗，与使用GC单一疗法方案相比，似乎更容易快速减量和停用GC。阿伐可泮未来可能成为一种有效的药物，在抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV），如肉芽肿性多血管炎（GPA）和显微镜下多血管炎（MPA）的缓解诱导期减少GC的使用。美泊利单抗是减少嗜酸性肉芽肿性多血管炎（EGPA）中GC使用的一个有前景的选择。
