2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis (Part 6)
Allow me to continue with our discussion of the guidelines of the American College of Rheumatology (ACR) in relation to the antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides (AAV).
Before we move towards our discussion, let us take a look anew at the terms that will be often appearing in this column. ANCA-AAV refers to the diseases known as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).
We are now going to discuss the treatment recommendations for active, nonsevere disease.
For patients with active, nonsevere GPA, experts recommend initiating treatment with methotrexate over cyclophosphamide or rituximab.
Nonsevere GPA is a form of GPA without life – or organ threatening risks.
Methotrexate, rituximab, and cyclophosphamide are excellent at inducing remission among patients with non-severe GPA.
However, like severe GPA, non-severe GPA can be a chronic disease that requires multiple courses of therapy.
Experts favor the use of therapies with potentially less toxicity before utilizing therapies with potentially more toxicity. Therefore, methotrexate is preferred due to the greater toxicity of cyclophosphamide.
Next week we will continue our discussion on treatments for ANCA-AAV.