Sharon A Chung1, Carol A Langford2, Mehrdad Maz3, Andy Abril4, Mark Gorelik5, Gordon Guyatt6, Amy M Archer7, Doyt L Conn8, Kathy A Full9, Peter C Grayson10, Maria F Ibarra11, Lisa F Imundo5, Susan Kim1, Peter A Merkel12, Rennie L Rhee12, Philip Seo13, John H Stone14, Sangeeta Sule15, Robert P Sundel16, Omar I Vitobaldi17, Ann Warner18, Kevin Byram19, Anisha B Dua7, Nedaa Husainat20, Karen E James21, Mohamad A Kalot22, Yih Chang Lin23, Jason M Springer3, Marat Turgunbaev24, Alexandra Villa-Forte2, Amy S Turner24, Reem A Mustafa25. 1. University of California, San Francisco. 2. Cleveland Clinic, Cleveland, Ohio. 3. University of Kansas Medical Center, Kansas City. 4. Mayo Clinic, Jacksonville, Florida. 5. Columbia University, New York, New York. 6. McMaster University, Hamilton, Ontario, Canada. 7. Northwestern University, Chicago, Illinois. 8. Emory University, Atlanta, Georgia. 9. Springfield, Illinois. 10. National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland. 11. Children's Mercy Hospital, Kansas City, Missouri. 12. University of Pennsylvania, Philadelphia. 13. Johns Hopkins University, Baltimore, Maryland. 14. Massachusetts General Hospital, Boston. 15. Children's National Hospital, Washington, DC. 16. Boston Children's Hospital, Boston, Massachusetts. 17. Chicago, Illinois. 18. Saint Luke's Health System, Kansas City, Missouri. 19. Vanderbilt University, Nashville, Tennessee. 20. SSM Health-St. Mary's Hospital, St Louis, Missouri. 21. University of Utah, Salt Lake City. 22. State University of New York at Buffalo. 23. University of South Florida, Tampa. 24. American College of Rheumatology, Atlanta, Georgia. 25. University of Kansas Medical Center, Kansas City, and McMaster University, Hamilton, Ontario, Canada.
Abstract
OBJECTIVE: To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). METHODS: Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS: We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations. CONCLUSION: This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases.
OBJECTIVE: To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). METHODS: Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel. RESULTS: We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations. CONCLUSION: This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases.
Authors: Safwat Eldaabossi; Mustafa Saad; Mohammed Alabdullah; Amgad Awad; Hussain Alquraini; Ghada Moumneh; Ali Mansour Journal: Int Med Case Rep J Date: 2021-12-20
Authors: Jack Arnold; Edward M Vital; Shouvik Dass; Aamir Aslam; Andy C Rawstron; Sinisa Savic; Paul Emery; Md Yuzaiful Md Yusof Journal: Front Immunol Date: 2022-01-12 Impact factor: 7.561