Leukocytoclastic Vasculitis Medication

Updated: Oct 25, 2018
  • Author: A Brooke W Eastham, MD; Chief Editor: Herbert S Diamond, MD  more...
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Medication

Medication Summary

No effective therapy has been established in all patients with leukocytoclastic vasculitis (LCV). The authors most frequently use colchicine or dapsone as first-line options in patients with cutaneous-predominant LCV, who may or may not have associated arthralgia. Agents used for LCV affecting internal organs, and for life-threatening LCV, include corticosteroids, cytotoxic/immunosuppressive agents (eg, cyclophosphamide), and rituximab. [42] Few therapies for LCV have been tested in controlled trials.

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Anti-inflammatory Agents

Class Summary

These agents inhibit key events involved in the inflammatory process.

Colchicine

Has effects against neutrophils, which are involved in the pathogenesis of cutaneous vasculitis. Has been demonstrated to be steroid sparing in open-label studies. The only double-blind, placebo-controlled trial failed to demonstrate efficacy; however, the study had several methodological errors.

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Antibiotics

Class Summary

Some types of antimicrobials (eg, dapsone) have anti-inflammatory properties.

Dapsone (Avlosulfon)

Small, open-label studies or single case reports have suggested that dapsone is effective in some patients with cutaneous vasculitis.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisone (Deltasone, Orasone, Meticorten)

Indicated for vasculitis affecting internal organs such as kidneys, lungs, or CNS. Skin involvement with bullous lesions may require corticosteroid therapy in order to prevent cutaneous ulceration and scarring.

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Cytotoxic/Immunosuppressive Agents

Class Summary

These agents inhibit cell growth and proliferation, decreasing immune reactions.

Cyclophosphamide (Cytoxan, Neosar)

Useful in life-threatening cases of vasculitis. Patients with only skin disease generally should not be treated with this agent. Useful in patients with polyarteritis nodosa, granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), and eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome). Alkylating agent that depresses T-cell and B-cell function.

Azathioprine (Imuran)

Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity.

Methotrexate (Rheumatrex, Folex PFS)

Unknown mechanism of action in treatment of inflammatory reactions; may affect immune function. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Adjust dose gradually to attain satisfactory response.

Mycophenolate mofetil (CellCept)

Inhibits inosine monophosphate dehydrogenase (IMPDH) and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. Inhibits antibody production.

Two formulations are available and are not interchangeable. The original formulation, mycophenolate mofetil (MMF, CellCept) is a prodrug that, once hydrolyzed in vivo, releases the active moiety mycophenolic acid. A newer formulation, mycophenolic acid (MPA, Myfortic) is an enteric-coated product that delivers the active moiety. The latter is often associated with less gastrointestinal disturbance.

Rituximab (Rituxan)

Antibody genetically engineered chimeric murine/human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. Antibody is an IgG1-kappa immunoglobulin that contains murine light- and heavy-chain variable region sequences and human constant region sequences.

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