Vasculitic neuropathy: Therapeutic progress and prospects

• Published in: Clinical & experimental neuroimmunology 2024-05, Vol.15 (2), p.94-100
• Main Author: Koga, Michiaki
• Format: Article
• Language: English
• Subjects: Antineutrophil cytoplasmic antibodies; antineutrophil cytoplasmic antibody‐associated vasculitis; Corticosteroids; Cyclophosphamide; guidelines; Immunotherapy; Neuropathy; nonsystemic vasculitic neuropathy; rituximab; Steroids; Sural nerve; vasculitic neuropathy; Vasculitis
• ISSN: 1759-1961; 1759-1961
• DOI: 10.1111/cen3.12781

Vasculitic neuropathy has a broad range of etiologies, and roughly comprises nonsystemic vasculitic neuropathy and neuropathies accompanied by antineutrophil cytoplasmic antibody‐associated vasculitis (AAV). Recent morphological analyses of sural nerve specimens from patients with vasculitic neuropathy showed some distinct pathogeneses within vasculitic neuropathy. Several randomized, controlled studies and updated practice guidelines cover immunotherapies for AAV, whereas there is a paucity of evidence for vasculitic neuropathy, including neuropathies associated with AAV. Corticosteroids have been the mainstay of immunotherapy for vasculitic neuropathy, and cyclophosphamide is indispensable for refractory cases. Recent AAV guidelines are shifting their recommendations toward minimizing the harm caused by corticosteroids and cyclophosphamide with a reduced‐dose corticosteroid regimen and the recent advent of various optional drugs, especially molecular‐targeted agents. Clinicians expect the efficacy of reduced‐dose corticosteroid regimens and molecular‐targeted agents in treating vasculitic neuropathy to be verified, and clarification of the mechanism of vasculitic neuropathy might lead to the development of the best treatment based on the background pathogenesis of individual cases.