What drug treats vasculitis? An overview of key medications

October 6, 2025 •

4 min read

According to NYU Langone Health, medication to reduce inflammation is the primary goal of most vasculitis treatment. A combination of corticosteroids and immune-suppressing drugs helps manage the condition, addressing the question of what drug treats vasculitis?.

Quick Summary

Treatment for vasculitis involves a multi-pronged medication approach, typically using corticosteroids for initial inflammation control and long-term immunosuppressants or biologics to maintain remission.

Key Points

Corticosteroids are the initial treatment: Drugs like prednisone are used to rapidly control severe inflammation during the induction phase of vasculitis treatment.
Long-term management uses immunosuppressants: For ongoing remission, doctors often transition patients to immunosuppressants like methotrexate or azathioprine to minimize the side effects of steroids.
Biologics offer targeted therapy: Newer drugs like rituximab and avacopan target specific parts of the immune system and are used for severe or specific types of vasculitis, sometimes reducing steroid dependence.
Treatment is highly individualized: The right drug and dosage depend on the specific type of vasculitis, its severity, and the organs affected, rather than a single standard approach.
Immunosuppression increases infection risk: Most vasculitis medications suppress the immune system, requiring patients to take precautions like staying up-to-date on vaccinations.
Two-phase treatment strategy: The plan involves an induction phase for achieving remission and a maintenance phase for preventing relapse, using different combinations of medications.

The central goal of treating vasculitis is to suppress the overactive immune system that attacks blood vessels, thereby controlling inflammation and preventing organ damage. Because vasculitis encompasses many distinct types, the ideal medication or combination of drugs is highly personalized, dependent on factors like severity, the organs affected, and the patient's overall health. Treatment generally follows a two-phase strategy: an initial, intensive induction phase to achieve remission, followed by a less potent maintenance phase to sustain remission and prevent relapse.

The Mainstays: Corticosteroids and Immunosuppressants

Corticosteroids

Corticosteroids, such as prednisone, are the cornerstone of initial treatment for most types of vasculitis due to their rapid and powerful anti-inflammatory effects. High doses are often used during the induction phase to quickly bring the disease under control, protecting vital organs from damage. However, long-term use of high-dose corticosteroids is associated with significant side effects, including weight gain, diabetes, osteoporosis, and mood changes. For this reason, doctors aim to taper the steroid dose once the disease is in remission, often by adding a different type of medication known as an immunosuppressant.

Conventional Immunosuppressants

These drugs are used to spare the long-term use of high-dose steroids, controlling inflammation over time with a different mechanism. Examples include:

Cyclophosphamide (Cytoxan): A powerful immunosuppressant typically reserved for severe or life-threatening vasculitis due to its potential toxicity. It is often used in combination with corticosteroids during induction for severe cases, with treatment later switched to a less toxic agent for maintenance.
Methotrexate (Trexall): Often used for milder forms of vasculitis and for long-term maintenance after remission has been achieved. It is typically given once weekly, with regular monitoring of blood counts and liver function.
Azathioprine (Imuran): A commonly used immunosuppressant for maintaining remission. It is considered safer for long-term use than cyclophosphamide, though regular monitoring is still necessary to check for liver toxicity and bone marrow suppression.
Mycophenolate Mofetil (CellCept): Used for maintenance therapy, it works by suppressing certain immune cells. Gastrointestinal side effects are relatively common.

Advanced Therapies: Biologic and Novel Agents

Biologic Therapies

Biologics are complex, lab-made proteins that target specific parts of the immune system to control inflammation. They offer greater specificity than older drugs, potentially reducing side effects.

Rituximab (Rituxan): An FDA-approved biologic for treating granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). It works by depleting B-cells, which are involved in inflammation.
Tocilizumab (Actemra): An anti-interleukin-6 (IL-6) receptor monoclonal antibody approved for giant cell arteritis (GCA). It is also being investigated for use in Takayasu arteritis.
Mepolizumab (Nucala): A biologic approved for eosinophilic granulomatosis with polyangiitis (EGPA), which targets the inflammatory cytokine IL-5.

Novel Oral Agents

Recent drug approvals are expanding treatment options for vasculitis.

Avacopan (Tavneos): An oral complement inhibitor that blocks the C5a receptor, reducing inflammation. It was approved for severe active ANCA-associated vasculitis and is used in combination with standard therapy, allowing for a quicker reduction of glucocorticoids.

Comparison of Key Vasculitis Medication Classes


Medication Class	Examples	Primary Function	Common Side Effects
Corticosteroids	Prednisone, Methylprednisolone	Rapidly reduce inflammation during the induction phase.	Weight gain, high blood pressure, diabetes, bone density loss, mood changes, insomnia.
Conventional Immunosuppressants	Methotrexate, Azathioprine, Cyclophosphamide	Suppress the immune system for long-term maintenance, allowing for steroid tapering.	Increased infection risk, nausea, diarrhea, liver damage, bone marrow suppression.
Biologics	Rituximab, Tocilizumab, Mepolizumab	Target specific inflammatory pathways (e.g., B-cells, cytokines) for more precise immune suppression.	Infusion reactions, headache, fatigue, increased risk of infection, GI issues.

Tailoring the Right Treatment Plan

Since vasculitis is a spectrum of diseases, a one-size-fits-all approach to medication is not effective. The right choice depends on the specific type of vasculitis, its severity, and which organs are involved. For instance, mild, skin-limited vasculitis might be managed with colchicine or dapsone, while severe, organ-threatening disease will require more potent immunosuppressants like cyclophosphamide or biologics. Your doctor will consider your medical history and other health conditions when creating a treatment plan, balancing efficacy with the management of side effects.

Managing the Side Effects of Vasculitis Medication

Many of the most effective vasculitis medications suppress the immune system, increasing susceptibility to infections. To mitigate this:

Stay up-to-date on vaccinations for diseases like flu, pneumonia, shingles, and COVID-19.
Eat a balanced diet to help counteract potential side effects like bone loss and blood sugar elevation.
Regular exercise can help improve mood and manage medication side effects.
Talk to your healthcare provider about any new or worsening symptoms.

Conclusion

There is no single answer to the question of what drug treats vasculitis? Instead, treatment relies on a personalized, phased approach using a combination of medication classes to control inflammation, achieve remission, and minimize side effects. Corticosteroids provide powerful initial control, while immunosuppressants and biologics offer targeted, long-term management. Close collaboration with a rheumatologist and consistent health monitoring are essential to navigating this complex condition. For additional resources, learn more about vasculitis and its treatments on the Vasculitis Foundation website.

Frequently Asked Questions

The primary goal of vasculitis medication is to reduce the inflammation in the blood vessels and suppress the immune system's attack on them, aiming to achieve remission and prevent damage to vital organs.

Corticosteroids, such as prednisone, are used because they are fast-acting, powerful anti-inflammatory drugs that can quickly bring severe vasculitis under control during the initial treatment phase.

Steroid-sparing medications are immunosuppressants, like methotrexate and azathioprine, that are used for long-term treatment to reduce the reliance on corticosteroids and minimize their long-term side effects.

Biologic drugs are engineered proteins that target and block specific parts of the immune system's inflammatory process. For example, rituximab targets B-cells, while tocilizumab blocks the IL-6 receptor.

Avacopan (Tavneos) is an add-on therapy, not a replacement for corticosteroids. It helps reduce blood vessel inflammation in ANCA-associated vasculitis, often allowing for a more rapid taper of glucocorticoids.

Common side effects include an increased risk of infections, weight gain, high blood pressure, and potential damage to organs like the liver or kidneys, depending on the specific drug.

Doctors tailor the treatment plan based on the type of vasculitis, its severity, the organs affected, and the patient's overall health history. Severe cases typically require more potent medications.