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  • Hellmich, BernhardUniversity of Tübingen (author)

EULAR recommendations for the management of ANCA-associated vasculitis : 2022 update

  • Article/chapterEnglish2024

Publisher, publication year, extent ...

  • 2023-03-16
  • BMJ,2024

Numbers

  • LIBRIS-ID:oai:lup.lub.lu.se:53e86b3c-7530-4ef6-b6de-a17ea1b63b57
  • https://lup.lub.lu.se/record/53e86b3c-7530-4ef6-b6de-a17ea1b63b57URI
  • https://doi.org/10.1136/ard-2022-223764DOI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • Background: Since the publication of the EULAR recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in 2016, several randomised clinical trials have been published that have the potential to change clinical care and support the need for an update. Methods: Using EULAR standardised operating procedures, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 16 countries. We modified existing recommendations and created new recommendations. Results: Four overarching principles and 17 recommendations were formulated. We recommend biopsies and ANCA testing to assist in establishing a diagnosis of AAV. For remission induction in life-threatening or organ-threatening AAV, we recommend a combination of high-dose glucocorticoids (GCs) in combination with either rituximab or cyclophosphamide. We recommend tapering of the GC dose to a target of 5 mg prednisolone equivalent/day within 4-5 months. Avacopan may be considered as part of a strategy to reduce exposure to GC in granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Plasma exchange may be considered in patients with rapidly progressive glomerulonephritis. For remission maintenance of GPA/MPA, we recommend rituximab. In patients with relapsing or refractory eosinophilic GPA, we recommend the use of mepolizumab. Azathioprine and methotrexate are alternatives to biologics for remission maintenance in AAV. Conclusions: In the light of recent advancements, these recommendations provide updated guidance on AAV management. As substantial data gaps still exist, informed decision-making between physicians and patients remains of key relevance.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Sanchez-Alamo, Beatriz (author)
  • Schirmer, Jan H.University Medical Center Schleswig-Holstein (author)
  • Berti, AlviseUniversity of Trento,Santa Chiara Hospital, Trento (author)
  • Blockmans, DanielUniversity Hospitals Leuven (author)
  • Cid, Maria C.University of Barcelona (author)
  • Holle, Julia U.Rheumazentrum Schleswig-Holstein Mitte (author)
  • Hollinger, NicoleUniversity of Tübingen (author)
  • Karadag, OmerHacettepe University (author)
  • Kronbichler, AndreasMedical University of Innsbruck (author)
  • Little, Mark A.Trinity College Dublin (author)
  • Luqmani, Raashid A.University of Oxford (author)
  • Mahr, AlfredKantonsspital St Gallen (author)
  • Merkel, Peter A.Hospital of the University of Pennsylvania (author)
  • Mohammad, Aladdin J.Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,University of Cambridge(Swepub:lu)reum-amo (author)
  • Monti, SaraPoliclinico San Matteo Pavia Fondazione,University of Pavia (author)
  • Mukhtyar, Chetan B.Norfolk and Norwich University Hospital NHS Trust (author)
  • Musial, JacekJagiellonian University (author)
  • Price-Kuehne, Fiona (author)
  • Segelmark, MårtenLund University,Lunds universitet,Njurmedicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Nephrology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital(Swepub:lu)njur-mse (author)
  • Teng, Y. K.OnnoLeiden University Medical Centre (author)
  • Terrier, BenjaminCochin Hospital (author)
  • Tomasson, GunnarNational University Hospital of Iceland (author)
  • Vaglio, AugustoMeyer Children's Hospital (author)
  • Vassilopoulos, DimitriosNational and Kapodistrian University of Athens (author)
  • Verhoeven, Peter (author)
  • Jayne, David (author)
  • University of TübingenUniversity Medical Center Schleswig-Holstein (creator_code:org_t)

Related titles

  • In:Annals of the Rheumatic Diseases: BMJ83:1, s. 30-470003-49671468-2060

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