{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T01:01:58Z","timestamp":1784336518729,"version":"3.55.0"},"reference-count":19,"publisher":"EDP Sciences","issue":"1-2","license":[{"start":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T00:00:00Z","timestamp":1721001600000},"content-version":"vor","delay-in-days":196,"URL":"https:\/\/www.edpsciences.org\/en\/authors\/copyright-and-licensing"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biologie Aujourd\u2019hui"],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:p>Les vascularites associ\u00e9es aux anticorps anti-cytoplasme des polynucl\u00e9aires neutrophiles (ANCA) r\u00e9unissent trois maladies, la granulomatose avec polyang\u00e9ite, la polyang\u00e9ite microscopique et la granulomatose \u00e9osinophilique avec polyang\u00e9ite. Ce groupe de maladies a b\u00e9n\u00e9fici\u00e9 au cours des trois derni\u00e8res d\u00e9cennies d\u2019avanc\u00e9es th\u00e9rapeutiques majeures tant en termes de strat\u00e9gies th\u00e9rapeutiques que de mise \u00e0 disposition de nouveaux m\u00e9dicaments, essentiellement pour des th\u00e9rapies cibl\u00e9es. Les traitements, conventionnels ou non, comprennent une phase d\u2019induction suivie d\u2019une phase d\u2019entretien. Le traitement d\u2019induction pose aujourd\u2019hui peu de probl\u00e8mes. Il est essentiellement fond\u00e9 sur l\u2019association cortico\u00efdes et rituximab ou cyclophosphamide. La r\u00e9mission est obtenue en moins de 6\u2009mois et un traitement d\u2019entretien, pr\u00e9ventif des rechutes, est alors initi\u00e9. Nous avons montr\u00e9 que le meilleur traitement d\u2019entretien \u00e9tait le rituximab, surpassant l\u2019effet du m\u00e9thotrexate ou de l\u2019azathioprine. Durant cette phase, la corticoth\u00e9rapie est arr\u00eat\u00e9e ou donn\u00e9e \u00e0 tr\u00e8s petite dose. Dans la granulomatose \u00e9osinophilique avec polyang\u00e9ite (GEPA), la strat\u00e9gie est un peu diff\u00e9rente et les essais prospectifs manquent pour d\u00e9montrer l\u2019int\u00e9r\u00eat du rituximab ou du m\u00e9polizumab (anti-IL5) en induction de la r\u00e9mission. En traitement d\u2019entretien, une corticoth\u00e9rapie prolong\u00e9e (par voie orale et\/ou inhal\u00e9e) est souvent n\u00e9cessaire pour contr\u00f4ler la maladie asthmatique. Seul le m\u00e9polizumab a montr\u00e9 sa capacit\u00e9 \u00e0 pr\u00e9venir les rechutes et \u00e0 r\u00e9duire la dose de cortico\u00efdes contr\u00f4lant l\u2019asthme. Les questions actuelles que pose le traitement d\u2019entretien sont notamment sa dur\u00e9e qui pourrait \u00eatre variable et adapt\u00e9e au risque de rechute et les risques induits par l\u2019immunod\u00e9pression prolong\u00e9e, notamment infectieux.<\/jats:p>","DOI":"10.1051\/jbio\/2024001","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T08:05:13Z","timestamp":1721030713000},"page":"19-24","source":"Crossref","is-referenced-by-count":1,"title":["Vascularites associ\u00e9es aux anticorps anti-cytoplasme des polynucl\u00e9aires neutrophiles (ANCA)\u00a0: actualit\u00e9s 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