| Drug |
Dose |
Other |
| Cyclophosphamide |
IV Pulses: 0.75 g/m2 q 3–4 weeks. 15 mg/Kg 2-weekly for 3 pulses, then 3-weekly for 3-6 pulses Decrease initial dose to 0.5 g/m2 if age 460 years or GFR o20 ml/min per 1.73m2.
Adjust subsequent doses to achieve a 2-week nadir leukocyte count 43000/mm3. |
Oral cyclophosphamide (2 mg/Kg/day) might be used
Adjusted to keep WBC >3,000/μL |
| Prednisone |
60 mg/day for 1 month tapered to 15 mg/day at 3 months |
IV methylprednisolone 500-1,000 mg/day for 3 days in critical organ manifestations |
| Rituximab IV |
375 mg/m2/week for 4 Pulses |
Use in intolerance to CYC and in young patients |
| Plasmapheresis |
60 ml/kg volume replacement.
Vasculitis: Seven treatments over 14 days If diffuse pulmonary hemorrhage, daily until the bleeding stops, then every other day, total 7–10 treatments. |
Use in critical organ manifestations
(serum creatinine >5.6 mg/dL, or lung hemorrhage) Vasculitis in association with anti-GBM antibodies: Daily for 14 days or until anti- GBM antibodies are undetectable |
| Methotrexate |
Starting dose 15 mg/week, increased to 20-25 mg/week at 2 months |
Use in non-critical organ manifestations
(normal serum creatinine) |
| Mycophenolate Mofetil |
2 g/day |
In patients with moderate renal
involvement who cannot take cyclophosphamide |
