PMID- 37479496
OWN - NLM
STAT- MEDLINE
DCOM- 20231103
LR  - 20231103
IS  - 2056-5933 (Electronic)
IS  - 2056-5933 (Linking)
VI  - 9
IP  - 3
DP  - 2023 Jul
TI  - Systematic literature review informing the 2022 update of the EULAR 
      recommendations for the management of ANCA-associated vasculitis (AAV): part 
      1-treatment of granulomatosis with polyangiitis and microscopic polyangiitis.
LID - 10.1136/rmdopen-2023-003082 [doi]
LID - e003082
AB  - OBJECTIVE: To summarise and update evidence to inform the 2022 update of the 
      EULAR recommendations for the management of antineutrophil cytoplasm 
      antibody-associated vasculitis (AAV). METHODS: A systematic literature review 
      (SLR) was performed to identify current evidence regarding treatment of AAV. 
      PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 
      February 2022. The evidence presented here is focused on the treatment of 
      granulomatosis with polyangiitis and microscopic polyangiitis. RESULTS: 3517 
      articles were screened and 175 assessed by full-text review. Ninety articles were 
      included in the final evidence synthesis. Cyclophosphamide and rituximab (RTX) 
      show similar efficacy for remission induction (level of evidence (LoE) 1a) but 
      RTX is more effective in relapsing disease (LoE 1b). Glucocorticoid (GC) 
      protocols with faster tapering result in similar remission rates but lower rates 
      of serious infections (LoE 1b). Avacopan can be used to rapidly taper and replace 
      GC (LoE 1b). Data on plasma exchange are inconsistent depending on the analysed 
      trial populations but meta-analyses based on randomised controlled trials 
      demonstrate a reduction of the risk of end-stage kidney disease at 1 year but not 
      during long-term follow-up (LoE 1a). Use of RTX for maintenance of remission is 
      associated with lower relapse rates compared with azathioprine (AZA, LoE 1b). 
      Prolonged maintenance treatment results in lower relapse rates for both, AZA (LoE 
      1b) and RTX (LoE 1b). CONCLUSION: This SLR provides current evidence to inform 
      the 2022 update of the EULAR recommendations for the management of AAV.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Schirmer, Jan Henrik
AU  - Schirmer JH
AUID- ORCID: 0000-0001-5467-2783
AD  - Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University 
      Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany 
      janhenrik.schirmer@uksh.de.
FAU - Sanchez-Alamo, Beatriz
AU  - Sanchez-Alamo B
AUID- ORCID: 0000-0002-7835-543X
AD  - Nephrology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain.
AD  - Nephrology, Skane University Hospital, Lund, Sweden.
FAU - Hellmich, Bernhard
AU  - Hellmich B
AUID- ORCID: 0000-0002-8014-1801
AD  - Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken 
      Kirchheim/Teck, University Tubingen, Kirchheim-Teck, Germany.
FAU - Jayne, David
AU  - Jayne D
AUID- ORCID: 0000-0002-1712-0637
AD  - Department of Medicine, University of Cambridge, Cambridge, UK.
FAU - Monti, Sara
AU  - Monti S
AUID- ORCID: 0000-0002-1800-6772
AD  - Department of Internal Medicine and Therapeutics, University of Pavia; Division 
      of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
FAU - Luqmani, Raashid Ahmed
AU  - Luqmani RA
AD  - Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics 
      Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
FAU - Tomasson, Gunnar
AU  - Tomasson G
AUID- ORCID: 0000-0002-1797-7091
AD  - Faculty of Medicine, University of Iceland, Landspitali University Hospital, 
      Reykjavik, Iceland.
LA  - eng
GR  - DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
PL  - England
TA  - RMD Open
JT  - RMD open
JID - 101662038
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
MH  - *Granulomatosis with Polyangiitis
MH  - Humans
MH  - *Microscopic Polyangiitis
MH  - *Cyclophosphamide/therapeutic use
MH  - *Rituximab/therapeutic use
MH  - Glucocorticoids
MH  - Remission Induction
PMC - PMC10364171
OTO - NOTNLM
OT  - cyclophosphamide
OT  - granulomatosis with polyangiitis
OT  - rituximab
OT  - systemic vasculitis
COIS- Competing interests: JHS received research grants from the John Grube Foundation 
      and the Deutsche Gesellschaft fur Rheumatologie (German Society for 
      Rheumatology). BH received speaker fees and/or consultancies from AbbVie, Amgen, 
      AstraZeneca, BMS, Boehringer, Chugai, GSK, InflaRx, Janssen, MSD, Pfizer, 
      Novartis, Phadia, Roche and Vifor. DJ received speaker fees and/or consultancies 
      from Amgen, AstraZeneca, BMS, Boehringer, Chemocentryx, GSK, InflaRx, Janssen, 
      Novartis, Roche, UCB and Vifor. RAL received speaker and/or consulting fees 
      and/or grants from AbbVie, BMS/Celgene, Chemocentryx, Chugai, GSK, InflaRx, 
      Pfizer Global, Roche and Vifor.
EDAT- 2023/07/22 10:42
MHDA- 2023/07/26 06:43
PMCR- 2023/07/21
CRDT- 2023/07/21 21:23
PHST- 2023/02/18 00:00 [received]
PHST- 2023/05/16 00:00 [accepted]
PHST- 2023/07/26 06:43 [medline]
PHST- 2023/07/22 10:42 [pubmed]
PHST- 2023/07/21 21:23 [entrez]
PHST- 2023/07/21 00:00 [pmc-release]
AID - rmdopen-2023-003082 [pii]
AID - 10.1136/rmdopen-2023-003082 [doi]
PST - ppublish
SO  - RMD Open. 2023 Jul;9(3):e003082. doi: 10.1136/rmdopen-2023-003082.