Vasculitis: lessons learned

Abstract

The routine use of cyclophosphamide dramatically changed the prognosis associated with systemic vasculitis, transforming many of these previously fatal diseases into chronic conditions. This advance, however, has come at a significant cost. Even with standard-of-care therapies, patients with systemic vasculitis continue to accumulate chronic morbidity, either as a result of the disease or the medications used for treatment [1]. Biologic therapies represent an important advance – replacing a blunt instrument with a scalpel – and have opened the possibility of treating severe forms of vasculitis with something other than a cytotoxic agent. It would, however, be premature to declare success. Early experience with biologic agents for the treatment of systemic vasculitis demonstrates that even under the best of circumstances, the reprieve is temporary. It seems fair to say that these agents do not change the fundamental characteristics of the underlying illness; they function more like levees against the storm waters, which work only as long as they remain in place. Moreover, the long-term consequences of many of these agents are not yet clear, and although many may seem both safe and effective after several years of use, the effects of several decades of use remain to be seen [2]. Although biologic therapies represent an important stepping stone, many fundamental challenges remain. The last several years have highlighted a few important themes.