Vasculitis Medications: List of Options for Mild to Severe Symptoms

Ruth Jessen Hickman, MD
·9 min read

Medically reviewed by David Snyder, PharmD

Healthcare providers use various medications to treat vasculitis, a sometimes severe condition that may cause organ damage or death. Treatment for vasculitis is evolving as newer therapies become available and scientists learn more about treating different kinds of vasculitis.

This article describes some primary treatment considerations when picking short- and long-term medications for vasculitis. It discusses the primary medications used to treat vasculitis, including corticosteroids, older medications that suppress the immune system, and newer biologic therapies that alter the immune response.

<p>Illustration by Michela Buttignol for Verywell Health</p>

Illustration by Michela Buttignol for Verywell Health

Considerations in Vasculitis Medications

It can be challenging to find the balance between minimizing drug side effects and treating and preventing vasculitis symptoms. Clinicians generally want to use the lowest doses of the safest drug possible while controlling symptoms.

Some important considerations in vasculitis treatment are treatment phase, severity, and type.

Treatment Phase

Healthcare providers often think about treating vasculitis in two phases. The goal of the initial treatment phase is to get symptoms under control. During this phase, clinicians often need to prescribe higher doses of more potent drugs—which may also come with significant side effects—and they may need to offer more than one drug.

This is followed by a maintenance phase, which aims to keep symptoms from returning. You might be able to use a less potent drug, a lower dose, or fewer overall drugs during this time. But if your symptoms return, treatment might need to be increased again.

Vasculitis Severity

The severity of your vasculitis also heavily impacts the treatment approach. You may need stronger medications or medication combinations if you have severe symptoms. Treatment with a less intense medication (or combination of drugs) may be sufficient for more mild disease.

Vasculitis Types

Different types of vasculitis affect blood vessels of different sizes, different vessel types, and vessels in different locations. Although they share some underlying similarities, different medications work better for some types of vasculitis compared to others. Not all medicines have been well studied in all types, and some are only approved by the Food and Drug Administration (FDA) for specific types.

Because of this, healthcare providers recommend different treatment approaches for different vasculitis types.

Prescribed Vasculitis Medications

Understanding the differences between corticosteroids, older immunosuppressive drugs, and newer immunosuppressive biologic treatments can be helpful when deciding the right treatment option for you.

Corticosteroids

A group of drugs called corticosteroids are a mainstay of treatment for all types of vasculitis. They are essential to get the disease under control during initial treatment.

In general, corticosteroids tone down the overactive immune response and inflammation of the blood vessels found in vasculitis. Usually, you use them in addition to immunosuppressive therapy.

Some people with severe disease may need to receive very high doses of a corticosteroid like Solu-medrol (methylprednisolone) in their veins. This gets the drug into your system as quickly as possible. Some people receive high doses of oral corticosteroids, like Deltasone (prednisone) or Orapred (prednisolone) instead.

Corticosteroids are often dropped during the maintenance phase. But in some cases, you might continue to use them in much lower doses.



Tapering Corticosteroids

Corticosteroids require a taper following treatment since taking these medications can suppress the body's ability to produce cortisol.



Older Immunosuppressive Therapies

Practitioners sometimes use several older, oral pharmaceutical immunosuppressive drugs to treat vasculitis. Although they all work slightly differently, the overall effect is to tamp down the overactive immune response. Some are also used in other autoimmune conditions.

Some of these drugs are commonly prescribed to people with mild vasculitis or who are in remission. Some examples include:

For example, someone just diagnosed with non-severe GPA-type vasculitis might take methotrexate along with glucocorticoids. Later, during the maintenance phase, they might take methotrexate without a glucocorticoid.

However, these older immunosuppressives sometimes benefit people with a severe form of the disease. An important example is Cytoxan (cyclophosphamide). For example, someone diagnosed with severe PAN-type vasculitis (polyarteritis nodosa vasculitis) might need Cytoxan along with high doses of glucocorticoids.

Newer Biologic Immunosuppressive Therapies

A variety of newer therapies are sometimes used to treat vasculitis. These are not technically chemical, or inorganic, drugs but rather biologics, a type of therapy made with the help of living organisms. Unlike the previous examples, they need to be taken into your veins or as an injection.

These biologics specifically target parts of the immune system that may be acting abnormally, like specific immune system signals. Many of these biologics are prescribed for other autoimmune conditions, and some also treat cancer.

Biologics that treat vasculitis include:

  • Kineret (anakinra)

  • Nucala (mepolizumab)

  • Actemra (tocilizumab)

  • Remicade (infliximab)

  • Rituxan (rituximab)

  • Orencia (abatacept)

For example, Kineret or Remicade might be part of the initial treatment for high-risk Kawasaki-type vasculitis; Actemra might be part of the initial treatment for giant cell arteritis-type vasculitis; and Nucala might be part of the initial treatment for nonsevere EGPA-type vasculitis (eosinophilic granulomatosis with polyangiitis vasculitis).

Rituxan is also an important example. It might be used, for example, as part of initial treatment for severe GPA-type vasculitis (granulomatosis with polyangiitis vasculitis), along with corticosteroids. Then, you might continue to take Rituxan during the maintenance phase but without the corticosteroids.



Other Medications

Additional medications may be needed to treat vasculitis in specific situations. For example, people who have vasculitis caused by a virus, such as hepatitis B, may need antiviral treatments, such as Rebetrol (ribavirin) and Intron A (interferon alpha).



How Long Are Patients on Vasculitis Medications?

Physicians and scientists debate how long people should stay on these treatments. It can vary, but you might remain on your initial vasculitis treatments for three to six months.

After that, your therapy might be stepped down during a maintenance phase. For example, you might stop taking steroids as part of your treatment, or you might take them at a much lower dose. In some cases, you might switch to a generally safer drug, such as from cyclophosphamide to methotrexate.

Scientists aren’t yet sure how long people should stay in this maintenance phase. But even for people whose symptoms don’t return, you may need to remain on some form of treatment for one to three years.

Side Effects of Vasculitis Medications

Prescription vasculitis medications vary somewhat in their side effects, although some overlap exists.

Risks of Infection

All prescription vasculitis medications are designed to tone down the immune system, so it’s not surprising they may increase the risk of some infections. When taking immunosuppressive medications, you are more susceptible to infections you might not otherwise get. There’s also a greater risk that such an infection would be severe.

On the whole, these risks of infection seem to be more significant for new biologic therapies compared to older oral immunosuppressive therapies. Corticosteroids like prednisone also have this effect, with the risk of infection increasing at higher doses.

Risks of Cancer

Some therapies also may slightly increase your risk of developing certain kinds of cancer. However, this varies significantly among the different treatments, and healthcare providers often don’t have reasonable estimates.

Additional Corticosteroid Side Effects

Corticosteroids have many potential side effects, both long term and short term, with increasing frequency and intensity at higher doses. Possible side effects include:

  • Increased appetite and weight gain, with increased fat around the abdomen

  • Upset stomach

  • Insomnia (trouble falling asleep or staying asleep)

  • Changes in mood (e.g., agitation, depression)

  • Thinning of the skin

  • Increased blood glucose (blood sugar)

  • High blood pressure (hypertension)

  • Osteoporosis (decrease in bone mineral density or bone mass)

  • Cataracts (the typically clear part of the eye becomes cloudy)

Steroids are important and sometimes lifesaving treatments. However, in recent years, healthcare providers have aimed to minimize steroids by only prescribing the lowest effective doses for the shortest time needed.

By using some of the older drug immunosuppressants or biologic immunosuppressants, you can reduce or eliminate the need for steroids, which can decrease overall long-term side effects.

Learn More: Prednisone Side Effects: Everything You Need to Know

Additional Side Effects of Older Drug (Non-Biologic) Immunosuppressants

These drugs can cause many different side effects. Some common side effects are diarrhea, nausea, mild hair loss, rash, fatigue, or headache.

Although rare, these drugs can cause more severe side effects, like the following:

Although cyclophosphamide is often very helpful in initially treating some kinds of severe vasculitis, it carries some considerable risks compared to some other drugs in this group. It can also cause additional and more severe issues, such as the following:

  • Even greater infection risks

  • Infertility in both men and women

  • Bladder injury

  • Well-documented increased risks of some cancers

Side Effects of Biologic Immunosuppressants

The side effects of biologic immunosuppressants vary, so you’ll want to learn about your particular treatment. Side effects from biologic immunosuppressants are often mild, like headache, fatigue, or pain at the injection site.

Compared to other biologic immunosuppressants, Rituxan is a little more potent, so it might cause more problems with infections. However, in addition to problems with infections, biologic immunosuppressants can also rarely cause serious issues, like the following:



Intravenous Immunoglobulin (IVIG)

It isn’t a medication, but IVIG is another potential treatment option for some kinds of vasculitis. It requires receiving several types of antibodies through a vein. It doesn’t come with the same risk of infection as other treatments. It’s most often prescribed to people with a disease that’s challenging to treat.



Over-the-Counter Vasculitis Medications

Most medications needed to treat vasculitis are available only with a prescription. However, over-the-counter (OTC) pain relievers may help reduce symptoms such as fever and body aches, but they are used for less serious cases or in addition to prescription drugs.

Examples include Advil (ibuprofen), Aleve (naproxen sodium), or Tylenol (acetaminophen). Talk to a healthcare provider before using OTC medications to ensure you can use them safely in your particular situation.

Summary

Most vasculitis treatments target the immune system and tone down the overactive response causing the disease. Your specific treatment will vary based on the type of vasculitis you have, its severity, and the treatment period. You’ll need more intense treatment right after you are first diagnosed, often with more than one drug, but eventually, you can move to a less intense regimen.

Corticosteroids, older drug immunosuppressants, and newer biologic immunosuppressants are the mainstays of treatment. Often, you’d start out using a corticosteroid in addition to one of these other therapies. Increased risk of other infections is one of these drugs’ most important potential side effects.

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