Microscopic Polyangiitis Medication

Updated: Aug 28, 2023
  • Author: Mehran Farid-Moayer, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Medication Summary

Various immunosuppressive agents are used in the treatment of microscopic polyangiitis (MPA). The choice of agents depends on the treatment phase (induction versus maintenance of remission) and disease severity.



Class Summary

First line of treatment for induction of remission and usually for maintenance. For induction of remission, use IV methylprednisolone. For maintenance, use prednisone.

Methylprednisolone (Adlone, Medrol, Solu-Medrol)

Steroids ameliorate effects immune reactions and may limit biphasic anaphylaxis.

Prednisone (Deltasone, Orasone, Sterapred)

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.


Immunosuppressive agents

Class Summary

These agents inhibit immune reactions that result from diverse stimuli.

Cyclophosphamide (Cytoxan, Neosar)

Chemically related to nitrogen mustards.

As an alkylating agent, the mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells.

Rituximab (Rituxan)

Chimeric murine/human monoclonal antibody directed against the CD20 antigen found on surface of B-lymphocytes. It is indicated in combination with glucocorticoids for treatment of adult and pediatric patients aged 2 years or older with granulomatosis with polyangiitis (GPA; Wegener granulomatosis) or microscopic polyangiitis (MPA).

Methotrexate (Folex PFS, Rheumatrex)

Should not be used if serum creatinine clearance is >2.0 mg/dL.

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. An alternative form of less toxic therapy only for localized and nonaggressive disease is combination of MTX and prednisone.

Azathioprine (Imuran)

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


Complement Inhibitors

Avacopan (Tavneos)

Complement 5a receptor (C5aR) antagonist that inhibits the interaction between C5aR and the anaphylatoxin C5a. Indicated as adjunctive treatment of severe active antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis) in combination with glucocorticoids.