Initial induction and maintenance therapy in patients with a diagnosis of GPA or MPA
Initial induction and maintenance therapy in patients with a diagnosis of GPA or MPA
This treatment algorithm applies to patients who are not pregnant. Induction therapy in pregnant patients requires modification due to the potential risk of fetal harm associated with some agents. Refer to UpToDate content on initial immunosuppressive therapy in pregnant patients with GPA or MPA.
GPA: granulomatosis with polyangiitis; MPA: microscopic polyangiitis; GBM: glomerular basement membrane; ANCA: antineutrophil cytoplasmic autoantibodies; eGFR: estimated glomerular filtration rate. * Refer to UpToDate content on the use of rituximab or cyclophosphamide as induction therapy for patients with GPA or MPA who have organ- or life-threatening disease. ¶ The role of plasma exchange, in addition to glucocorticoids and either cyclophosphamide or rituximab, among patients with GPA or MPA is controversial. Refer to UpToDate content on plasma exchange in patients with GPA or MPA. Δ Contraindications to methotrexate include, but are not limited to, heavy alcohol use, chronic liver disease, eGFR <60 mL/min/1.73 m2, or evidence of renal vasculitis. Refer to UpToDate content on management of non-organ- and non-life-threatening GPA or MPA. ◊ Rituximab is preferred for most patients who achieve remission after induction therapy. Azathioprine, methotrexate, and mycophenolate are reasonable alternatives to rituximab and may be preferred based on other patient-specific factors, such as a prior history of toxicity from a certain drug and/or a comorbid condition that increases the risk of toxicity with a specific agent. Refer to UpToDate content on the choice of maintenance therapy in patients with GPA or MPA.
