Tanaz Kermani, MD, on ANCA-Associated Vasculitis Treatment Strategies

In this podcast, Tanaz Kermani, MD, MS, provides an in-depth look at antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Listen as she discusses treatment strategies, duration of therapy, and the timing of renal transplantation for patients with microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), or eosinophilic granulomatosis with polyangiitis (EGPA).

Additional Resources:

• Lyons PA, Rayner TF, Trivedi S, et al. Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med 2012;367:214-223. doi:10.1056/NEJMoa1108735
• Damoiseaux J, Csernok E, Rasmussen N, et al. Detection of antineutrophil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays. Ann Rheum Dis 2017;76(4):647-653. doi:10.1136/annrheumdis-2016-209507
• Stone JH, Merkel PA, Spiera R, et al; RAVE−ITN research group. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363:221-232. doi:10.1056/NEJMoa0909905
• Jones RB, Tervaert JWC, Hauser T, et al; European Vasculitis Study Group. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010;363:211-220. doi:10.1056/NEJMoa0909169
• Walsh M, Merkel PA, Peh CA, et al; PEXIVAS investigators. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med. 2020;382(7):622-631. doi:10.1056/NEJMoa1803537
• Wechsler ME, Akuthota P, Jayne D, et al; EGPA mepolizumab study team. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med. 2017;376(20):1921-1932. doi:10.1056/NEJMoa1702079
• Mohammad AJ, Hot A, Arndt F, et al. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Ann Rheum Dis 2016;75(2):396-401. doi:10.1136/annrheumdis-2014-206095
• Puéchal X, Iudici M, Calich AL, et al. Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients. Rheumatology (Oxford). 2019;58(3):401-409. doi:10.1093/rheumatology/key117 
• Guillevin L, Pagnoux C, Karras A et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med 2014;371(19):1771-1780. doi:10.1056/NEJMoa1404231
• Gopaluni S, Smith RM, Lewin M, et al; RITAZAREM investigators. Rituximab versus azathioprine as therapy for maintenance of remission for anti-neutrophil cytoplasm antibody-associated vasculitis (RITAZAREM): study protocol for a randomized controlled trial. Trials. 2017;18(1):112. doi:10.1186/s13063-017-1857-z
• Yates M, Watts RA, Bajema IM, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. 2016;75(9):1583-1594. doi:10.1136/annrheumdis-2016-209133
• Jayne DRW, Bruchfeld AN, Harper L, et al; CLEAR study group. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J Am Soc Nephrol. 2017;28(9):2756-2767. doi:10.1681/ASN.2016111179
• Merkel PA, Jayne DR, Wang C, et al. Evaluation of the safety and efficacy of avacopan, a C5a receptor inhibitor, in patients with antineutrophil cytoplasmic antibody-associated vasculitis treated concomitantly with rituximab or cyclophosphamide/azathioprine: protocol for a randomized, double-blind, active-controlled, phase 3 trial. JMIR Res Protoc. 2020;9:e1666. doi:10.2196/16664
• Langford CA, Monach PA, Specks U, et al. An open-label trial of abatacept (CTLA4-IG) in non-severe relapsing granulomatosis with polyangiitis (Wegener's). Ann Rheum Dis. 2014;73:1376-1379. doi:10.1136/annrheumdis-2013-204164

Tanaz Kermani, MD, MS, is an associate clinical professor in the Division of Rheumatology at the University of California, Los Angeles, where she is also director of the multidisciplinary Vasculitis Program.