I'm treating with corticosteroids a patient with Immunoglobulin G4 (IgG4)–related disease with /periaortitis and periarteritis that are possible vascular manifestations. Each time I reach 15mg of prednisone the patient relapses. I'm looking for an effective second line treatment.
Thank you in advance for your answers.
Therapeutic alternatives to corticosteroids have not been well-established in IgG4-RD. In some case reports and small case series, some oral immunosuppressive drugs, including azathioprine [27], methotrexate [28] and mycophenolate mofetil [29], have been reported to be effective. In addition, good effectiveness of rituximab, which eliminates B cells by binding the cell-surface marker CD20, has been described [30, 31]. However, the efficacy of these drugs remains to be evaluated with regard to their effectiveness for periaortic/periarterial lesions and their influence on luminal dilatation in IgG4-related PAo/PA.
When you bring up the article in first message above it references on right side of page a series of related articles.
For relapsed IgG4-RD the use of immunomodulatory drugs such as azathioprine has been considered to be appropriate. B cell depletion with rituximab (an anti-CD20 antibody) is also effective. We could considered as third line therapy an association with mycophenolic acid and low dose of steroid.
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