Which medications in the drug class Immunosuppressants are used in the treatment of Granulomatosis with Polyangiitis (GPA, formerly Wegener Granulomatosis)?

Updated: Aug 31, 2021
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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These agents are useful in patients who experience significant adverse effects with cyclophosphamide induction therapy, as induction therapy in mild to moderate disease, and, most commonly, for maintenance of remission. The immunosuppressive drug is generally started at a lower dose and gradually increased over time. The onset of effect generally takes several weeks; therefore, the use of these drugs in induction therapy for severe disease is not advised.

Azathioprine (Imuran, Azasan)

Azathioprine inhibits mitosis and cellular metabolism by antagonizing purine metabolism and inhibiting the synthesis of DNA, ribonucleic acid (RNA), and proteins. Its effects may decrease the proliferation of immune cells and result in lower autoimmune activity.

Methotrexate (Rheumatrex, Trexall)

Methotrexate has an unknown mechanism of action in the treatment of inflammatory reactions; it may affect immune function. This agent ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Adjust the dose gradually to attain a satisfactory response.

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