Multiple Options for ANCA Vasculitis Treatment, But Questions Remain

The last decade has brought a clearer understanding of the pathogenesis and, subsequently, treatment of antineutrophil cytoplasmic antibody (ANCA) vasculitis, according to a review article published in Kidney360.

“We have been successful in improving patient prognosis, with earlier remissions and lower relapse rates,” wrote corresponding author Koyal Jain, MD, and coauthors from University of North Carolina Kidney Center in Chapel Hill. “However, many questions remain unanswered including optimal timing of treatments, and, more importantly, when to withdraw therapy.”

The review article offers a comprehensive overview of the current evidence for managing patients with ANCA vasculitis, as well as protocols used by clinicians at the UNC Kidney Center.

Options for inducing remission include corticosteroids, although controversy exists over their optimal dosing and duration; and cyclophosphamide, rituximab, or a combination of both, depending on the patient’s needs. Plasma exchange is supported by American Society of Apheresis guidelines for a subset of patients with severe acute kidney failure and lung hemorrhage, according to the review. The authors advised limiting plasma exchange to that population and also recommended kidney biopsy, when safe and indicated, to rule out concomitant disease.

Similarly, multiple options exist for maintaining remission in patients with ANCA vasculitis. They include rituximab, azathioprine, mycophenolate, methotrexate, and glucocorticoids.

“Rituximab has gained popularity as a single agent and in combination, and there are new trials underway that may again change the landscape in the next decade,” the authors wrote. “Our understanding of the pathogenesis continues to expand and reveals the complexity of the disease.”

—Jolynn Tumolo

Reference
Jain K, Jawa P, Derebail VK, Falk RJ. Treatment updates in antineutrophil cytoplasmic autoantibodies (ANCA) vasculitis. Kidney360. 2021;2(4):763-770. doi:10.34067/KID.0007142020