Table 1.

Infliximab Use in Wegener's Granulomatosis

Table 2.

Rituximab Use in Wegener's Granulomatosis

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Wegener's Granulomatosis Etanercept Trial (WGET) Research Group. Etanercept plus standard therapy for Wegener's granulomatosis. N Engl J Med 2005; 352:351-361.
Leonardi CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl J Med 2003; 349:2014-2022.
Papp KA, Tyring S, Lahfa M, et al. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol 2005; 152:1304-1312.
Sandborn WJ, Hanauer SB, Katz S, et al. Etanercept for active Crohn's disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2001; 121:1088-1094.
Utz JP, Limper AH, Kalra S, et al. Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis. Chest 2003; 124:177-185.
Lamprecht P, Voswinkel J, Lilienthal T, et al. Effectiveness of TNF-alpha blockade with infliximab in refractory Wegener's granulomatosis. Rheumatology (Oxford) 2002; 41:1303-1307.
Bartolucci P, Ramanoelina J, Cohen P, et al. Efficacy of the anti-TNF-alpha antibody infliximab against refractory systemic vasculitides: an open pilot study on 10 patients. Rheumatology (Oxford) 2002; 41:1126-1132.
Booth A, Harper L, Hammad T, et al. Prospective study of TNFalpha blockade with infliximab in antineutrophil cytoplasmic antibody-associated systemic vasculitis. J Am Soc Nephrol 2004; 15:717-721.
Aries PM, Hellmich B, Gross WL. Intravenous immunoglobulin therapy in vasculitis: speculation or evidence? Clin Rev Allergy Immunol 2005; 29:237-245.
Kaneko Y, Nimmerjahn F, Ravetch JV. Anti-inflammatory activity of immunoglobulin G resulting from Fc sialylation. Science 2006; 313:670-673.
Oates-Whitehead RM, Baumer JH, Haines L, et al. Intravenous immunoglobulin for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2003; (4): CD004000.
Asano Y, Ihn H, Maekawa T, et al. High-dose intravenous immunoglobulin infusion in polyarteritis nodosa: report on one case and review of the literature. Clin Rheumatol 2006; 25:396-398.
Hamidou MA, Pottier MA, Dupas B. Intravenous immunoglobulin in Henoch-Schonlein purpura. Ann Intern Med 1996; 125:1013-1014.
Jayne DR, Davies MJ, Fox CJ, et al. Treatment of systemic vasculitis with pooled intravenous immunoglobulin. Lancet 1991; 337:1137-1139.
Tuso P, Moudgil A, Hay J, et al. Treatment of antineutrophil cytoplasmic autoantibody-positive systemic vasculitis and glomerulonephritis with pooled intravenous gammaglobulin. Am J Kidney Dis 1992; 20:504-508.
Richter C, Schnabel A, Csernok E, et al. Treatment of Wegener's granulomatosis with intravenous immunoglobulin. Adv Exp Med Biol 1993; 336:487-489.
Jayne DR, Lockwood CM. Intravenous immunoglobulin as sole therapy for systemic vasculitis. Br J Rheumatol 1996; 35:1150-1153.
Levy Y, Sherer Y, George J, et al. Serologic and clinical response to treatment of systemic vasculitis and associated autoimmune disease with intravenous immunoglobulin. Int Arch Allergy Immunol 1999; 119:231-238.
Jayne DR, Chapel H, Adu D, et al. Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. QJM 2000; 93:433-439.
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Eriksson P. Nine patients with antineutrophil cytoplasmic antibody-positive vasculitis successfully treated with rituximab. J Intern Med 2005; 257:540-548.
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Author(s)

Sharon A. Chung, MD

Division of Rheumatology, University of California, San Francisco

Disclosures

Disclosure: Sharon A. Chung, MD, has received funding from the American College of Rheumatology Research and Education Foundation Physician Scientist Development Award.

Philip Seo, MD, MHS

Division of Rheumatology, The Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland

Disclosures

Disclosure: Philip Seo, MD, MHS, has disclosed that he is a Lowe Family Scholar in the Johns Hopkins University Center for Innovative Medicine and has received funding from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Editor(s)

Philip Seo, MD, MHS

Division of Rheumatology, The Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland

Disclosures

Disclosure: Philip Seo, MD, MHS, has disclosed that he is a Lowe Family Scholar in the Johns Hopkins University Center for Innovative Medicine and has received funding from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Helen Fosam, PhD

Editorial Director, Medscape Rheumatology

Disclosures

Disclosure: Helen Fosam, PhD, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD, FAAFP

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, FAAFP, has disclosed that he has served as an advisor or consultant to Novartis, Inc.

CME

Advances in the Use of Biologic Agents for the Treatment of Systemic Vasculitis

Authors: Sharon A. Chung, MD ; Philip Seo, MD, MHS
THIS ACTIVITY HAS EXPIRED FOR CREDIT

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, rheumatologists, and other physicians who care for patients with systemic vasculitis.

The goal of this activity is to describe the use of biologic agents for systemic vasculitis.

Upon completion of this activity, participants will be able to:

Describe the characteristics of biologic agents
Identify the efficacy and safety of antitumor necrosis factor agents in the treatment of systemic vasculitis
Describe the results of research into the use of intravenous immunoglobulin for systemic vasculitis
Identify the outcomes of treatment with rituximab in the treatment of systemic vasculitis

Disclosures

Author(s)

Sharon A. Chung, MD

Division of Rheumatology, University of California, San Francisco

Disclosures

Disclosure: Sharon A. Chung, MD, has received funding from the American College of Rheumatology Research and Education Foundation Physician Scientist Development Award.

Philip Seo, MD, MHS

Division of Rheumatology, The Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland

Disclosures

Disclosure: Philip Seo, MD, MHS, has disclosed that he is a Lowe Family Scholar in the Johns Hopkins University Center for Innovative Medicine and has received funding from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Editor(s)

Philip Seo, MD, MHS

Division of Rheumatology, The Johns Hopkins Vasculitis Center, Johns Hopkins University, Baltimore, Maryland

Disclosures

Disclosure: Philip Seo, MD, MHS, has disclosed that he is a Lowe Family Scholar in the Johns Hopkins University Center for Innovative Medicine and has received funding from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Helen Fosam, PhD

Editorial Director, Medscape Rheumatology

Disclosures

Disclosure: Helen Fosam, PhD, has disclosed no relevant financial relationships.

CME Author(s)

Charles P. Vega, MD, FAAFP

Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, FAAFP, has disclosed that he has served as an advisor or consultant to Novartis, Inc.

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Abstract and Introduction

Abstract

Purpose of Review: Due to the well known toxicities of cyclophosphamide, substantial interest exists in finding other therapies to treat primary systemic vasculitis. Biologic agents have been proposed as an alternative to cyclophosphamide for these disorders because of their recent success in treating other rheumatic diseases. This article reviews the current state-of-the-art therapy with regards to the use of biologic agents as treatments for systemic vasculitis.
Recent Findings: The greatest amount of experience with these agents for the treatment of systemic vasculitis is with antitumor necrosis factor agents, pooled intravenous immunoglobulin, and anti-B-cell therapies such as rituximab. Intravenous immunoglobulin is already a standard therapy for Kawasaki's disease, but should also be considered for the treatment of vasculitis associated with antineutrophil cytoplasmic antibodies when standard therapies are either ineffective or contraindicated. Early experience with tumor necrosis factor inhibitors indicates that they may be effective for the treatment of Takayasu's arteritis, but their role in the treatment of other forms of vasculitis remains controversial. Early experience with rituximab for the treatment of several forms of vasculitis has been quite promising, but must be confirmed by ongoing randomized clinical trials.
Summary: Biologic agents represent the next evolution in treatment for the primary systemic vasculitides. Greater understanding of these diseases has allowed us to move further away from nonspecific, highly toxic therapies toward a more directed approach. As our experience with these agents increases, they will likely form the keystone of treatment in the near future.

Introduction

Cytotoxic agents are the cornerstone of treatment for many forms of primary systemic vasculitis. Drugs such as cyclophosphamide have vastly improved the previously dismal prognosis associated with many of these diseases. Due to the toxicities associated with cyclophosphamide, however, there has been substantial interest in finding alternate agents for treatment of these disorders. With the recent success of biologic agents for the treatment of many autoimmune disorders, there has been great interest in using these agents to treat systemic vasculitis.

Page 1 of 5

Antitumor Necrosis Factor Agents

References

Table 1.

Table 2.

References

Faculty and Disclosures

Author(s)

Sharon A. Chung, MD

Philip Seo, MD, MHS

Editor(s)

Philip Seo, MD, MHS

Helen Fosam, PhD

CME Author(s)

Charles P. Vega, MD, FAAFP

CME

Advances in the Use of Biologic Agents for the Treatment of Systemic Vasculitis

Target Audience and Goal Statement

Disclosures

Author(s)

Sharon A. Chung, MD

Philip Seo, MD, MHS

Editor(s)

Philip Seo, MD, MHS

Helen Fosam, PhD

CME Author(s)

Charles P. Vega, MD, FAAFP

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Advances in the Use of Biologic Agents for the Treatment of Systemic Vasculitis

Abstract and Introduction

Abstract

Introduction

Table of Contents