{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T05:24:36Z","timestamp":1761715476313,"version":"build-2065373602"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"22","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Was ist neu?<\/jats:title>\n                  <jats:p>Glukokortikoide (GC) werden zur Remissionsinduktion der ANCA-assoziierte Vaskulitiden (AAV) in Kombination mit Cyclophosphamid (CYC) oder Rituximab (RTX) eingesetzt. Besonderes Augenmerk liegt gegenw\u00e4rtig auf der Reduktion von GC. Der GC-Toxicity-Index (GTI) erlaubt eine objektive Quantifizierung unerw\u00fcnschter GC-Effekte. Die PEXIVAS-Studie hat eine deutlich reduzierte GC-Dosierung etabliert und ist in der KDIGO-Leitlinie als Standard in der Kombination mit CYC und RTX aufgef\u00fchrt.<\/jats:p>\n                  <jats:p>Die ADVOCATE-Studie zeigt, dass Avacopan in Kombination mit RTX oder CYC eine weitere deutliche GC-Reduktion erm\u00f6glicht und dabei die anhaltende Remissionsrate nach 1 Jahr wahrscheinlich sogar erh\u00f6ht. Durch Avacopan wurde der GTI signifikant verringert. Avacopan war dar\u00fcber hinaus nephroprotektiv und besonders vorteilhaft, je st\u00e4rker die eGFR zum Therapiebeginn eingeschr\u00e4nkt war. Real-world-Studien zu Avacopan zeigen allerdings ein Verbesserungspotenzial bei der praktischen Umsetzung der Avacopantherapie auf. Ein fr\u00fcher Beginn und eine konsequente GC-Reduktion sind anzustreben.<\/jats:p>\n                  <jats:p>Die gr\u00f6\u00dfte randomisierte Studie konnte keinen Vorteil einer zus\u00e4tzlichen Plasmaaustausch-Therapie (PLEX) nachweisen. Basierend auf einer Metaanalyse kommt KDIGO dennoch zu der Empfehlung, dass eine PLEX-Behandlung zwar keine Routinetherapie darstellt, aber bei Patienten mit Kreatinin &gt;300\u00b5mol\/l (3,4mg\/dl), initialer Dialyse und bei rapide ansteigendem Serum-Kreatinin \u00fcberlegt werden kann. Dabei sollte das damit verbundene erh\u00f6hte Risiko f\u00fcr schwere Infektionen ber\u00fccksichtigt werden. KDIGO erw\u00e4gt PLEX auch bei hypox\u00e4mischen Patienten mit diffuser Lungenblutung. Die Grundlagen f\u00fcr diese Aussagen werden diskutiert.<\/jats:p>\n                  <jats:p>Die KDIGO-Empfehlungen zur remissionserhaltenden Therapie haben sich nicht ge\u00e4ndert. Die Experten sprechen allerdings eine Pr\u00e4ferenz f\u00fcr RTX aus, insbesondere bei PR3-AAV, nach einem Relapse und nach Induktion mit RTX.<\/jats:p>","DOI":"10.1055\/a-2502-1480","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T23:58:13Z","timestamp":1761695893000},"page":"1355-1359","source":"Crossref","is-referenced-by-count":0,"title":["KDIGO-Update: Therapie der ANCA-Vaskulitis"],"prefix":"10.1055","volume":"150","author":[{"given":"Ralph","family":"Kettritz","sequence":"additional","affiliation":[{"name":"Nephrologie und Internistische Intensivmedizin Charit\u00e9-Universit\u00e4tsmedizin Berlin, Charit\u00e9-Universit\u00e4tsmedizin, Berlin"},{"name":"a joint cooperation between the Charit\u00e9 Medical Faculty and the Max-Delbr\u00fcck Center for Molecular Medicine, Experimental and Clinical Research Center, Berlin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/S0140-6736(23)01736-1","article-title":"Diagnosis and management of ANCA-associated vasculitis","volume":"403","author":"A Kronbichler","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e300","DOI":"10.1016\/S2665-9913(24)00025-0","article-title":"Myeloperoxidase-specific antineutrophil cytoplasmic antibody-associated vasculitis","volume":"6","author":"S Arnold","year":"2024","journal-title":"Lancet Rheumatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e314","DOI":"10.1016\/S2665-9913(24)00035-3","article-title":"Proteinase 3-specific antineutrophil cytoplasmic antibody-associated vasculitis","volume":"6","author":"SD Falde","year":"2024","journal-title":"Lancet Rheumatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1002\/art.41773","article-title":"2021 American College of Rheumatology\/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis","volume":"73","author":"SA Chung","year":"2021","journal-title":"Arthritis Rheumatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1136\/ard-2022-223764","article-title":"EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update","volume":"83","author":"B Hellmich","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S71","DOI":"10.1016\/j.kint.2023.10.008","article-title":"Improving Global Outcomes AVWG. 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