Abstract
Biological therapies enable us to apply highly selective targeting components to modulate the immune response. Until now, a few controlled studies investigated the efficacy of TNF-alpha blocking agents in systemic vasculitis have been carried out, but, in general, they were falling short of expectations. However, there is conducive evidence that TNF-alpha blockers are advantageous in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, at least in selected disease stages. Likewise, although the efficacy of the monoclonal CD20 antibody rituximab in ANCA-associated vasculitis is obvious, the effect on predominantly granulomatous disease activity in Wegener's granulomatosis is less clear. In addition, interferon-alpha is used for induction treatment particularly in Churg-Strauss syndrome. Even though the effectiveness and safety of short-term administration was confirmed by case series, severe side effects after long-term treatment relativized the initial results. This review presents the recent data on the use of biologicals in vasculitis and appraises the knowledge in the clinical context.
MeSH terms
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Antibodies, Antineutrophil Cytoplasmic* / adverse effects
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Antibodies, Antineutrophil Cytoplasmic* / immunology
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Antibodies, Antineutrophil Cytoplasmic* / physiology
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Antibodies, Monoclonal / adverse effects
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Antibodies, Monoclonal / blood
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Murine-Derived
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Antirheumatic Agents / adverse effects
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Antirheumatic Agents / therapeutic use*
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Biological Therapy / methods*
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Churg-Strauss Syndrome / drug therapy*
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Etanercept
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Granulomatosis with Polyangiitis / drug therapy*
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Granulomatosis with Polyangiitis / etiology
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Granulomatosis with Polyangiitis / physiopathology
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Humans
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Immunoglobulin G / adverse effects
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Immunoglobulin G / blood
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Immunoglobulin G / therapeutic use
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Immunologic Factors / therapeutic use*
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Infliximab
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Interferon-alpha / therapeutic use*
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Randomized Controlled Trials as Topic
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Receptors, Tumor Necrosis Factor / blood
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Receptors, Tumor Necrosis Factor / therapeutic use
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Rituximab
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Tumor Necrosis Factor-alpha / antagonists & inhibitors*
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Tumor Necrosis Factor-alpha / blood
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Tumor Necrosis Factor-alpha / immunology
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Vasculitis / drug therapy*
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Vasculitis / etiology
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Vasculitis / immunology
Substances
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Antibodies, Antineutrophil Cytoplasmic
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Antirheumatic Agents
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Immunoglobulin G
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Immunologic Factors
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Interferon-alpha
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Receptors, Tumor Necrosis Factor
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Tumor Necrosis Factor-alpha
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Rituximab
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Infliximab
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Etanercept