Unmet needs in ANCA-associated vasculitis: Physicians’ and patients’ perspectives

In recent years, clinical research has increased significantly and therapies for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis have improved. However, there are still unanswered questions and unmet needs about AAV patients. The purpose of this review is to examine the frontiers of research related to emerging biomarkers eventually predicting relapse, and new therapeutic approaches, not to mention new quality of life assessment tools. Identifying predictors of relapse may help optimize therapeutic strategies, minimize disease recurrence, and reduce treatment-related side effects. In addition, it is important to recognize that patients may suffer long-term consequences of the disease and its treatment, which, although life-saving, is often associated with significant side effects. Our goal, therefore, is to highlight what has been achieved, the pitfalls, and what still needs to be done, comparing the views of physicians and patients.

[1]  B. Tampe,et al.  Tailored Use of Avacopan in a Case With Refractory Antineutrophil Cytoplasmic Antibody-Associated Renal Vasculitis and Concominant Complement System Activation , 2022, Kidney international reports.

[2]  M. Konig,et al.  Autoreactive Plasmablasts After B Cell Depletion With Rituximab and Relapses in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2022, Arthritis & rheumatology.

[3]  A. Ekici,et al.  Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus , 2022, Nature Medicine.

[4]  L. Mouthon,et al.  Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2022, JAMA network open.

[5]  S. Cong,et al.  Long-Term Prognostic Factors in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A 15-Year Multicenter Retrospective Study , 2022, Frontiers in Immunology.

[6]  C. Klersy,et al.  Factors influencing patient-reported outcomes in ANCA-associated vasculitis: correlates of the Patient Global Assessment. , 2022, Seminars in arthritis and rheumatism.

[7]  P. Merkel,et al.  AB0626 Prevalence of Frailty in an Internet-Based Cohort with a Self-Reported Diagnosis of Vasculitis – The VascStrong Study , 2022, Annals of the Rheumatic Diseases.

[8]  K. Thomas,et al.  AB0633 Health-Related Quality of Life in ANCA Vasculitides and Rheumatoid Arthritis patients: a cross-sectional comparative study , 2022, Annals of the Rheumatic Diseases.

[9]  S. Sartorelli,et al.  AB0627 Evaluation of internal consistency, feasibility, and reliability of the Italian version of ANCA-associated vasculitis patient-reported outcome (AAV-PRO_ita) questionnaire: preliminary results from a multicenter study on a large cohort of Italian patients , 2022, Annals of the Rheumatic Diseases.

[10]  L. Mouthon,et al.  Remission and Low Disease Activity in Granulomatosis With Polyangiitis and Microscopic Polyangiitis: Prevalence and Impact on Damage Accrual , 2022, Arthritis care & research.

[11]  I. Gunnarsson,et al.  Pentraxin-3 – a potential biomarker in ANCA-associated vasculitis , 2022, Scandinavian journal of rheumatology.

[12]  J. Robson,et al.  ANCA Associated Vasculitis Subtypes: Recent Insights and Future Perspectives , 2022, Journal of inflammation research.

[13]  A. Chaudhry,et al.  Alemtuzumab for refractory primary systemic vasculitis—a randomised controlled dose ranging clinical trial of efficacy and safety (ALEVIATE) , 2022, Arthritis Research & Therapy.

[14]  A. Gaffo,et al.  Clinical Features of ANCA-Associated Vasculitis in African American Patients in the United States , 2022, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[15]  B. Bonnotte,et al.  Comparative study of granulomatosis with polyangiitis subsets according to ANCA status: data from the French Vasculitis Study Group Registry , 2022, RMD Open.

[16]  G. Guyatt,et al.  Comparative efficacy and safety of alternative glucocorticoids regimens in patients with ANCA-associated vasculitis: a systematic review , 2022, BMJ Open.

[17]  P. Merkel,et al.  2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for granulomatosis with polyangiitis , 2022, Annals of the Rheumatic Diseases.

[18]  P. Merkel,et al.  2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis , 2022, Annals of the Rheumatic Diseases.

[19]  P. Merkel,et al.  2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis , 2022, Annals of the Rheumatic Diseases.

[20]  T. Rabelink,et al.  Compassionate Use of Avacopan in Difficult-to-Treat Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2021, Kidney international reports.

[21]  S. Shinjo,et al.  Mortality predictors in ANCA-associated vasculitis , 2021, Medicine.

[22]  J. Robson,et al.  Patient reported outcomes in systemic vasculitis , 2021, Current opinion in rheumatology.

[23]  J. Yazdany,et al.  The Relationship Between Electronic Health Record System and Performance on Quality Measures in the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) Registry: Observational Study , 2021, JMIR medical informatics.

[24]  M. Schönermark,et al.  Hohe Krankheitslast bei Patienten mit ANCA-assoziierter Vaskulitis , 2021, Der Internist.

[25]  W. Ng,et al.  Fatigue in inflammatory rheumatic diseases: current knowledge and areas for future research , 2021, Nature Reviews Rheumatology.

[26]  Lorena M. Salto,et al.  ANCA-associated vasculitis in Caucasian and Hispanics of the Inland Empire of Southern California , 2021, Clinical Rheumatology.

[27]  M. Gatto,et al.  IgG anti-Pentraxin 3 antibodies are a novel biomarker of ANCA-associated vasculitis and better identify patients with eosinophilic granulomatosis with polyangiitis. , 2021, Journal of autoimmunity.

[28]  G. Guyatt,et al.  2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2021, Arthritis & rheumatology.

[29]  E. Daugas,et al.  ANCA-Negative Pauci-immune Necrotizing Glomerulonephritis: A Case Series and a New Clinical Classification. , 2021, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[30]  K. Hiromura,et al.  Effect of Reduced-Dose vs High-Dose Glucocorticoids Added to Rituximab on Remission Induction in ANCA-Associated Vasculitis: A Randomized Clinical Trial. , 2021, JAMA.

[31]  K. Polkinghorne,et al.  The impact of antineutrophil cytoplasmic antibody‐associated vasculitis on employment and work disability in an Australian population , 2021, International journal of rheumatic diseases.

[32]  Jean-Paul Makhzoum,et al.  Update in the Management of ANCA-Associated Vasculitis: Recent Developments and Future Perspectives , 2021, International journal of rheumatology.

[33]  A. Meara,et al.  ANCA-Associated Vasculitis: An Update , 2021, Journal of clinical medicine.

[34]  P. Merkel,et al.  Avacopan for the Treatment of ANCA-Associated Vasculitis. , 2021, The New England journal of medicine.

[35]  C. Selmi,et al.  The biology, pathogenetic role, clinical implications, and open issues of serum anti-neutrophil cytoplasmic antibodies. , 2021, Autoimmunity reviews.

[36]  Nathan P. Dawkins,et al.  Management of fatigue with physical activity and behavioural change support in vasculitis: a feasibility study. , 2020, Rheumatology.

[37]  J. V. van Dongen,et al.  Highly Sensitive Flow Cytometric Detection of Residual B-Cells After Rituximab in Anti-Neutrophil Cytoplasmic Antibodies-Associated Vasculitis Patients , 2020, Frontiers in Immunology.

[38]  C. Roubille,et al.  Comorbidities and health-related quality of life in Patients with Antineutrophil Cytoplasmic Antibody (ANCA) - associated vasculitis. , 2020, Autoimmunity reviews.

[39]  C. Selmi,et al.  Frailty in Rheumatic Diseases , 2020, Frontiers in Immunology.

[40]  J. C. Tervaert,et al.  Vasculitis patient journey: a scoping review of patient experiences with vasculitis , 2020, Clinical Rheumatology.

[41]  P. Merkel,et al.  Use and reporting of outcome measures in randomized trials for anti-neutrophil cytoplasmic antibody-associated vasculitis: a systematic literature review of randomized trials. , 2020, Seminars in arthritis and rheumatism.

[42]  R. Rudin,et al.  Digital health technologies: opportunities and challenges in rheumatology , 2020, Nature Reviews Rheumatology.

[43]  F. Valent,et al.  Healthcare and economic burden of ANCA-associated vasculitis in Italy: an integrated analysis from clinical and administrative databases , 2020, Internal and Emergency Medicine.

[44]  Lindsay Lally,et al.  Localized Granulomatous with Polyangiitis (GPA): Varied Clinical Presentations and Update on Treatment , 2020, Current Allergy and Asthma Reports.

[45]  S. Zheng,et al.  Pentraxin 3: A promising therapeutic target for autoimmune diseases. , 2020, Autoimmunity reviews.

[46]  Johannes Leierer,et al.  Comorbidities in ANCA-associated vasculitis , 2020, Rheumatology.

[47]  Qi Zhao Bispecific Antibodies for Autoimmune and Inflammatory Diseases: Clinical Progress to Date , 2020, BioDrugs.

[48]  N. Zhang,et al.  Reduced activated regulatory T cells and imbalance of Th17/activated Treg cells marks renal involvement in ANCA-associated vasculitis. , 2019, Molecular immunology.

[49]  X. Mariette,et al.  Immunization to rituximab is more frequent in systemic autoimmune diseases than in rheumatoid arthritis: ofatumumab as alternative therapy. , 2019, Rheumatology.

[50]  A. Diepstra,et al.  CD27+CD38hi B Cell Frequency During Remission Predicts Relapsing Disease in Granulomatosis With Polyangiitis Patients , 2019, Front. Immunol..

[51]  R. Hunter,et al.  Long-term outcomes in elderly patients with ANCA-associated vasculitis , 2019, Rheumatology.

[52]  L. Graça,et al.  T follicular helper cells and T follicular regulatory cells in rheumatic diseases , 2019, Nature Reviews Rheumatology.

[53]  R. B. Henderson,et al.  Efficacy and Safety of Belimumab and Azathioprine for Maintenance of Remission in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: A Randomized Controlled Study , 2019, Arthritis & Rheumatology.

[54]  A. Caristan,et al.  Dampening of CD8+ T Cell Response by B Cell Depletion Therapy in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2019, Arthritis & rheumatology.

[55]  Courtney A. Roberts,et al.  Economic and objective burden of caregiving on informal caregivers of patients with systemic vasculitis. , 2019, Musculoskeletal care.

[56]  D. Misra,et al.  Is granulomatosis with polyangiitis in Asia different from the West? , 2018, International journal of rheumatic diseases.

[57]  J. Levy,et al.  A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody–associated vasculitis , 2018, Rheumatology.

[58]  N. Basu,et al.  The Longitudinal Course of Fatigue in Anca Associated Vasculitis. , 2019, The Journal of rheumatology.

[59]  P. Garred,et al.  Pentraxins in Complement Activation and Regulation , 2018, Front. Immunol..

[60]  P. Ravaud,et al.  Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides , 2018, Annals of the rheumatic diseases.

[61]  V. Ravindran,et al.  Digital health: a new dimension in rheumatology patient care , 2018, Rheumatology International.

[62]  P. Merkel,et al.  Validation of the ANCA-associated vasculitis patient-reported outcomes (AAV-PRO) questionnaire , 2018, Annals of the rheumatic diseases.

[63]  M. Singhal,et al.  Clinical features and long‐term outcomes of 105 granulomatosis with polyangiitis patients: A single center experience from north India , 2017, International journal of rheumatic diseases.

[64]  C. Salvarani,et al.  Unmet Needs in the Pathogenesis and Treatment of Vasculitides , 2018, Clinical Reviews in Allergy & Immunology.

[65]  N. Alcocer-Castillejos,et al.  Patient and physician perspectives on the impact of health-related quality of life in Mexican patients with ANCA-associated vasculitis , 2018, Rheumatology International.

[66]  K. Kishibe,et al.  A novel strategy with combined assays for detection of anti-neutrophil cytoplasmic antibody (ANCA) in clinically ANCA-negative granulomatosis with polyangiitis patients. , 2017, Auris, nasus, larynx.

[67]  N. Belfeki,et al.  Granulomatosis with polyangiitis in Tunisia. , 2017, Reumatismo.

[68]  Kenneth G. C. Smith,et al.  Association of a TNFSF13B (BAFF) regulatory region single nucleotide polymorphism with response to rituximab in antineutrophil cytoplasmic antibody-associated vasculitis. , 2017, The Journal of allergy and clinical immunology.

[69]  L. Mouthon,et al.  Employment, work disability and quality of life in patients with ANCA-associated vasculitides. The EXPOVAS study. , 2016, Clinical and experimental rheumatology.

[70]  M. Petri,et al.  Development of a Glucocorticoid Toxicity Index (GTI) using multicriteria decision analysis , 2016, Annals of the rheumatic diseases.

[71]  R. Pereira,et al.  Recommendations of the Brazilian Society of Rheumatology for the induction therapy of ANCA-associated vasculitis. , 2017, Revista brasileira de reumatologia.

[72]  N. Basu,et al.  Physical Fatigue, Fitness, and Muscle Function in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis , 2016, Arthritis care & research.

[73]  J. C. Cohen Tervaert,et al.  Editorial: Can an Increase in Antineutrophil Cytoplasmic Autoantibody Titer Predict Relapses in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis? , 2016, Arthritis & rheumatology.

[74]  P. Merkel,et al.  EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis , 2016, Annals of the rheumatic diseases.

[75]  R. Hubbard,et al.  Incidence of ANCA-associated vasculitis in a UK mixed ethnicity population. , 2016, Rheumatology.

[76]  C. Pusey,et al.  Ofatumumab for B cell depletion therapy in ANCA-associated vasculitis: a single-centre case series , 2016, Rheumatology.

[77]  C. Feighery,et al.  Urinary Soluble CD163 in Active Renal Vasculitis. , 2016, Journal of the American Society of Nephrology : JASN.

[78]  A. Mantovani,et al.  Detection of Anti-Pentraxin-3 Autoantibodies in ANCA-Associated Vasculitis , 2016, PloS one.

[79]  P. Merkel,et al.  Clinical outcomes of treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on ANCA type , 2015, Annals of the rheumatic diseases.

[80]  U. Maggiore,et al.  Association of Serum C3 Concentration and Histologic Signs of Thrombotic Microangiopathy with Outcomes among Patients with ANCA-Associated Renal Vasculitis. , 2015, Clinical journal of the American Society of Nephrology : CJASN.

[81]  Kenneth G. C. Smith,et al.  Long-term follow-up of patients who received repeat-dose rituximab as maintenance therapy for ANCA-associated vasculitis. , 2015, Rheumatology.

[82]  V. Tesar,et al.  Treatment of Severe Renal Disease in ANCA Positive and Negative Small Vessel Vasculitis with Rituximab , 2015, American Journal of Nephrology.

[83]  Yichun Hu,et al.  Gleaning relapse risk from B cell phenotype: decreased CD5+ B cells portend a shorter time to relapse after B cell depletion in patients with ANCA-associated vasculitis , 2015, Annals of the rheumatic diseases.

[84]  P. Emery,et al.  Repeat cycles of rituximab on clinical relapse in ANCA-associated vasculitis: identifying B cell biomarkers for relapse to guide retreatment decisions , 2015, Annals of the rheumatic diseases.

[85]  P. Ravaud,et al.  Treatment of Systemic Necrotizing Vasculitides in Patients Aged Sixty‐Five Years or Older: Results of a Multicenter, Open‐Label, Randomized Controlled Trial of Corticosteroid and Cyclophosphamide–Based Induction Therapy , 2015, Arthritis & rheumatology.

[86]  N. Basu,et al.  Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. , 2015, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[87]  P. van Paassen,et al.  ANCA as a predictor of relapse: useful in patients with renal involvement but not in patients with nonrenal disease. , 2015, Journal of the American Society of Nephrology : JASN.

[88]  P. Cacoub,et al.  Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. , 2014, Autoimmunity reviews.

[89]  Yichun Hu,et al.  Clinical characteristics and outcome of pauci-immune glomerulonephritis in African Americans. , 2014, Seminars in arthritis and rheumatism.

[90]  D. Reid,et al.  Markers for work disability in anti-neutrophil cytoplasmic antibody-associated vasculitis. , 2014, Rheumatology.

[91]  S. Ito,et al.  Classification and characteristics of Japanese patients with antineutrophil cytoplasmic antibody-associated vasculitis in a nationwide, prospective, inception cohort study , 2014, Arthritis Research & Therapy.

[92]  N. Basu,et al.  Autoantibodies to hLAMP-2 in ANCA-negative pauci-immune focal necrotizing GN. , 2014, Journal of the American Society of Nephrology : JASN.

[93]  Min Chen,et al.  Alternative complement pathway activation products in urine and kidneys of patients with ANCA-associated GN. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[94]  A. V. van Beek,et al.  Androgen deficiency in male patients diagnosed with ANCA-associated vasculitis: a cause of fatigue and reduced health-related quality of life? , 2013, Arthritis Research & Therapy.

[95]  E. Lee,et al.  The clinicopathologic characteristics of granulomatosis with polyangiitis (Wegener’s): a retrospective study of 45 patients in Korea , 2013, Modern rheumatology.

[96]  G. Waiter,et al.  Fatigue-related brain white matter changes in granulomatosis with polyangiitis. , 2013, Rheumatology.

[97]  P. Heeringa,et al.  Epitope specificity determines pathogenicity and detectability in ANCA-associated vasculitis. , 2013, The Journal of clinical investigation.

[98]  Kenneth G. C. Smith,et al.  Leukocyte and serum S100A8/S100A9 expression reflects disease activity in ANCA-associated vasculitis and glomerulonephritis , 2013, Kidney international.

[99]  Sandrine Katsahian,et al.  Revisiting the classification of clinical phenotypes of anti-neutrophil cytoplasmic antibody-associated vasculitis: a cluster analysis , 2012, Annals of the rheumatic diseases.

[100]  P. Merkel,et al.  2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. , 2013, Arthritis and rheumatism.

[101]  Yeong-Wook Song,et al.  ANCA-associated vasculitis: report from Korea , 2013, Clinical and Experimental Nephrology.

[102]  T. Dörner,et al.  Rationale of anti-CD19 immunotherapy: an option to target autoreactive plasma cells in autoimmunity , 2012, Arthritis Research & Therapy.

[103]  P. Merkel,et al.  IgA and IgG antineutrophil cytoplasmic antibody engagement of Fc receptor genetic variants influences granulomatosis with polyangiitis , 2011, Proceedings of the National Academy of Sciences.

[104]  F. Arnett,et al.  DRB1*15 allele is a risk factor for PR3-ANCA disease in African Americans. , 2011, Journal of the American Society of Nephrology : JASN.

[105]  J. Bena,et al.  Pilot study to assess the frequency of fibromyalgia, depression, and sleep disorders in patients with granulomatosis with polyangiitis (Wegener's) , 2011, Arthritis care & research.

[106]  R. Bertina,et al.  Anti-plasminogen antibodies compromise fibrinolysis and associate with renal histology in ANCA-associated vasculitis. , 2010, Journal of the American Society of Nephrology : JASN.

[107]  P. Merkel,et al.  Patient‐reported outcome assessment in vasculitis may provide important data and a unique perspective , 2010, Arthritis care & research.

[108]  P. Merkel,et al.  Rituximab versus cyclophosphamide for ANCA-associated vasculitis. , 2010, The New England journal of medicine.

[109]  P. van Paassen,et al.  Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. , 2010, The New England journal of medicine.

[110]  S. Ndongo,et al.  [Systemic vasculitis: study of 27 cases in Senegal]. , 2010, Medecine tropicale : revue du Corps de sante colonial.

[111]  M. Gobbi,et al.  Regulation of leukocyte recruitment by the long pentraxin PTX3 , 2010, Nature Immunology.

[112]  Katrien G Luijkx,et al.  Toward a conceptual definition of frail community dwelling older people. , 2010, Nursing outlook.

[113]  V. Tesar,et al.  Reduced number of endothelial progenitor cells is predictive of early relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis. , 2009, Rheumatology.

[114]  F. Luft,et al.  C5a receptor mediates neutrophil activation and ANCA-induced glomerulonephritis. , 2009, Journal of the American Society of Nephrology : JASN.

[115]  David Steven Scott,et al.  Modification and validation of the Birmingham Vasculitis Activity Score (version 3) , 2008, Annals of the rheumatic diseases.

[116]  E. Reinhold-Keller,et al.  Cyclophosphamid oral vs. Bolus bei Wegener-Granulomatose und anderen ANCA-assoziierten Vaskulitiden , 2008, Zeitschrift für Rheumatologie.

[117]  M. Haubitz,et al.  Diagnostic role of endothelial microparticles in vasculitis. , 2008, Rheumatology.

[118]  N. Chen,et al.  Analyzing Fatal Cases of Chinese Patients with Primary Antineutrophil Cytoplasmic Antibodies-Associated Renal Vasculitis: A 10-Year Retrospective Study , 2008, Kidney and Blood Pressure Research.

[119]  Min Chen,et al.  Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis in Older Patients , 2008, Medicine.

[120]  L. Onetti,et al.  [Wegener's granulomatosis: its prevalence in a ten-year period in the rheumatology service of the Clinic Hospital, Cordoba, Argentina]. , 2006, Revista de la Facultad de Ciencias Medicas.

[121]  Ying Zhang,et al.  Characteristics of Chinese patients with Wegener's granulomatosis with anti-myeloperoxidase autoantibodies. , 2005, Kidney international.

[122]  G. EduardoWainstein,et al.  Clinical features of Wegener granulomatosis and microscopic polyangiitis in Chilean patients , 2005 .

[123]  C. Kallenberg,et al.  Urinary monocyte chemoattractant protein-1 (MCP-1) is a marker of active renal vasculitis. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[124]  D. Scott,et al.  Investigation of quality of life, mood, pain, disability, and disease status in primary systemic vasculitis. , 2003, Arthritis and rheumatism.

[125]  M. Haubitz,et al.  Circulating endothelial cells as markers for ANCA-associated small-vessel vasculitis , 2003, The Lancet.

[126]  P. Pfitzenmeyer,et al.  Vasculitis in the Very Elderly , 2002, Gerontology.

[127]  C. Gordon,et al.  Development and initial validation of the Vasculitis Damage Index for the standardized clinical assessment of damage in the systemic vasculitides. , 1997, Arthritis and rheumatism.

[128]  C. Hack,et al.  Wegener's granulomatosis autoantibodies identify a novel diisopropylfluorophosphate-binding protein in the lysosomes of normal human neutrophils. , 1989, The Journal of clinical investigation.

[129]  R. Falk,et al.  Anti-neutrophil cytoplasmic autoantibodies with specificity for myeloperoxidase in patients with systemic vasculitis and idiopathic necrotizing and crescentic glomerulonephritis. , 1988, The New England journal of medicine.

[130]  A. Fauci,et al.  Effect of cyclophosphamide upon the immune response in Wegener's granulomatosis. , 1971, The New England journal of medicine.