ANCA-associated vasculitis

Abstract
GPA/MPA Induction of Remission: The ADVOCATE trial demonstrated that avacopan significantly reduces glucocorticoid (GC) use during the induction of remission in GPA and MPA. Avacopan is expected to play a future role in the treatment of these conditions. Similarly, the PEXIVAS trial showed that a 60% reduction in GC dosage, compared to the standard dose, was equally effective. The same trial also found no additional benefit from plasma exchange when added to standard induction therapy, making plasma exchange largely obsolete in current practice.

GPA/MPA Maintenance: Rituximab is well-established as a maintenance therapy for AAV, although the optimal duration remains uncertain. The MAINRITSAN 3 study suggests that extended use beyond two years may offer additional benefits.

EGPA: Consistent with earlier clinical findings, a genome-wide association study (GWAS) involving 534 EGPA patients identified at least two distinct subgroups. This supports the differentiation between a primarily “vasculitic” phenotype and a more “eosinophilic” phenotype, which could lead to more tailored therapeutic approaches. The IL-5 antibody, mepolizumab, represents the first targeted treatment for the eosinophilic component of EGPA, and clinical studies have shown it to be Avacopan effective.