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Update on antineutrophil cytoplasmic antibody vasculitis
Dan A Mandel1, Nishitha Shekhar1, Ramy Hanna2
1Department of Medicine, Division of Rheumatology.
Current Opinion in Nephrology and Hypertension
|December 29, 2025
Summary
Antineutrophil cytoplasmic antibody (ANCA) vasculitis treatment has evolved significantly, moving from high mortality to treatable outcomes. Current strategies focus on rituximab and avacopan, reducing steroid toxicity and improving patient survival.
Area of Science:
- Rheumatology
- Nephrology
- Pulmonology
- Immunology
Background:
- Antineutrophil cytoplasmic antibody (ANCA) vasculitis, encompassing microscopic polyangiitis and granulomatosis with polyangiitis, historically had high mortality.
- Significant advancements in understanding and treatment have transformed ANCA vasculitis into a manageable condition.
Purpose of the Study:
- To review the evolution of ANCA vasculitis treatment guidelines and therapeutic strategies.
- To highlight the impact of major clinical trials on current treatment options, morbidity, and survival rates.
Main Methods:
- Review of major clinical trials and guideline development in ANCA vasculitis.
- Analysis of treatment shifts from cyclophosphamide to rituximab for induction and maintenance.
- Evaluation of emerging therapies like avacopan for steroid-sparing regimens.
Main Results:
- Treatment has shifted from toxic agents like cyclophosphamide to rituximab, improving outcomes.
- Avacopan offers a C5a inhibitor-based approach, enabling faster steroid reduction.
- Ongoing research explores novel therapeutic targets for ANCA vasculitis.
Conclusions:
- ANCA vasculitis presents complex, varied clinical manifestations requiring multidisciplinary specialist collaboration.
- Effective diagnosis and organ-sparing, life-saving treatments are achievable through collaborative efforts.
- Continued research into novel targets promises further improvements in ANCA vasculitis management.
Keywords:
antineutrophil cytoplasmic antibodygranulomatosis with polyangiitismicroscopic polyangiitistreatmentvasculitisMore Related Videos
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