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ANCA-associated vasculitis: a phase-oriented therapeutic framework from immunopathology to precision treatment
Elena Treppo1, Simone Longhino1, Benedetta Fazzi1
1Rheumatology Division, Department of Medicine, Academic Hospital "Santa Maria della Misericordia," Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), University of Udine, Udine, Italy.
Frontiers in Medicine
|July 22, 2026
Summary
A new phase-oriented framework reframes Antineutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis treatment beyond induction and maintenance. This approach tailors therapy to disease stage, mechanisms, and patient risk for better outcomes.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare, severe autoimmune diseases.
- Current management models (induction/maintenance) don't fully address disease complexity and transitions.
- AAV involves necrotizing small-vessel inflammation, diverse organ involvement, and significant patient burden.
Purpose of the Study:
- To propose a novel phase-oriented therapeutic framework for AAV management.
- To integrate disease stage, pathogenic mechanisms, organ risk, and clinical needs for precise treatment.
- To shift AAV treatment from a rigid sequence to a mechanism-based strategy.
Main Methods:
- Review of current AAV management strategies and immunopathological transitions.
- Proposal of a three-phase model: induction, consolidation, and maintenance.
- Consideration of factors like clinical severity, renal pathology, complement, ANCA type, and toxicity risk.
Main Results:
- The proposed framework emphasizes rapid inflammation control and organ damage prevention in the induction phase.
- Consolidation involves stabilizing remission, suppressing autoreactive circuits, and tapering glucocorticoids.
- Maintenance is redefined as individualized surveillance, relapse prevention, and toxicity minimization.
Conclusions:
- The phase-oriented framework offers a more precise and actionable approach to AAV treatment.
- It moves beyond a simple induction-maintenance dichotomy towards a mechanism-based strategy.
- Treatment intensity should be matched to immunopathology, evidence, and patient-specific risk.
