maintenance therapy

Maintenance therapy is typically the final phase of a multi-step treatment plan, following induction therapy (which achieves remission or initial control) and, in some cases, consolidation therapy (which eliminates residual disease). The goal of maintenance therapy is to prevent relapse or disease progression using lower-intensity, often better-tolerated regimens over an extended period.

Key examples relevant to boards: - Oncology: Acute lymphoblastic leukemia (ALL) treatment includes induction, consolidation, and maintenance phases (e.g., low-dose methotrexate and 6-mercaptopurine for 2-3 years). Multiple myeloma patients often receive maintenance lenalidomide after autologous stem cell transplant. - Infectious disease: HIV patients require lifelong antiretroviral maintenance therapy to suppress viral load. Patients with cryptococcal meningitis or disseminated fungal infections need maintenance antifungal therapy (e.g., fluconazole) to prevent relapse, especially in immunocompromised hosts. - Psychiatry: Maintenance therapy with mood stabilizers (lithium) or antipsychotics is used to prevent relapse in bipolar disorder and schizophrenia after acute episode stabilization. - Asthma: Long-term controller medications (inhaled corticosteroids) are considered maintenance therapy to prevent exacerbations, as opposed to rescue/reliever therapy (short-acting beta-agonists). - Transplant medicine: Immunosuppressive maintenance regimens (tacrolimus, mycophenolate, corticosteroids) prevent graft rejection long-term.

Clinical significance: Understanding the distinction between induction, consolidation, and maintenance phases is important for boards, as different drugs/doses are used in each phase, and toxicity profiles differ. Maintenance therapy often uses lower doses or less intensive agents to minimize toxicity while still preventing relapse, and treatment duration can range from months to lifelong, depending on the disease.