Highlights from the breakout session: optimising new treatments.

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• ANCA-associated vasculitis (AAV) management traditionally relies on glucocorticoids (GCs), which have significant side effects.
• Emerging therapies aim to spare patients from long-term GC use.
• Novel treatments target specific inflammatory pathways implicated in AAV pathogenesis.

Purpose of the Study:

• To present emerging real-world evidence on novel GC-sparing therapies for AAV.
• To discuss the role of avacopan and anti-interleukin-5 therapies in AAV management.
• To highlight the importance of real-world data for evaluating new AAV treatments.

Main Methods:

• Review of emerging real-world evidence on avacopan and anti-interleukin-5 therapies.
• Discussion of clinical trial data (ADVOCATE, MIRRA, MANDARA) informing treatment guidelines.
• Analysis of the integration of new therapies into clinical practice and guidelines (KDIGO 2024).

Main Results:

• Avacopan, a C5a receptor antagonist, is approved for severe granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), offering an alternative to GCs for remission induction.
• Anti-interleukin-5 therapies (mepolizumab, benralizumab) are effective in sustaining remission for eosinophilic granulomatosis with polyangiitis (EGPA).
• Real-world data are vital for assessing the efficacy and safety of these novel agents in broader patient populations.

Conclusions:

• Novel GC-sparing therapies, including avacopan and anti-interleukin-5 agents, represent significant advancements in AAV treatment.
• Clinical guidelines increasingly incorporate these new options, reflecting their therapeutic potential.
• Continued evaluation through real-world evidence is essential to optimize AAV patient care and outcomes.