2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis (Part 7)
Let us 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).
Again, just to remind my dear readers, let us take a look anew at the terms that will be often appearing in this column. ANCA-AAV is comprised of the diseases known as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA).
The experts st the American College of Rheumatology, the patients with active, nonsevere GPA, it is conditionally recommend to start the treatment with methotrexate and glucocorticoids over azathioprine and glucocorticoids or mycophenolate mofetil and glucocorticoids.
The use of methotrexate among this patient group is supported by robust data than other treatments, but azathioprine and mycophenolate mofetil can be used.
More trials are needed in order to see the efficacy of methotrexate, azathioprine, and mycophenolate mofetil for remission induction in active, nonsevere GPA.
There are certain factors which may influence the treatment selection. For example, methotrexate should be avoided in patients with moderate-to-severe renal problems. Azathioprine is the better for pregnant patients or in patients who cannot tolerate methotrexate or mycophenolate mofetil, while methotrexate or mycophenolate mofetil can be used in patients with total thiopurine S-methyltransferase deficiency.
We will continue next week with the other recommendations on the treatment modalities for patients with ANCA-AAV.