ANCA Associated Vasculitis (AAV) - Take Home Points - PART 2

This is a continuation from Part 1 of the ANCA Associated Vasculitis take home points. An absolutely wonderful lecture given by Dr. Peter Merkel and I just had to share everything I could.

ANCA titres do not predict flare. Several analyses including RAVE have not shown that ANCA titres predict flares in AAV. Some recent studies have found predictive value for ANCA for specific clinical subsets - i.e. renal disease or alveolar hemorrhage. But the use of ANCA titres to guide therapy for individual patients remains problematic and is not advised until more research is available on the specific context.

ANCA type is a POWERFUL clinical predictor of relapse. Patients with MPO have considerably fewer relapses than those with PR3. In the 18-month RAVE trial there was a significant and remarkable difference in relapse rates based on ANCA type independent of treatment. The relapse rate for PR3 AAV is significantly higher than that for MPO AAV.

Relapses can occur years after remission. The Vasculitis Clinical Research Consortium has data (unpublished) that looks at the time after remission until first relapse. More than 50% of patients will ultimately relapse and it happens up to 5 years after remission is achieved.

Patients who relapse are at seemingly higher risk of further relapse.

Relapse is extremely common in AAV but not all relapses have the same impact. The impact of arthritis or sinus disease may be less than that of glomerulonephritis, diffuse alveolar hemorrhage, or mono neuritis multiplex.

The vast MAJORITY of patients (>90%) will enter remission with current standard induction regimens. Keeping patients in remission is the big challenge.

Over the past 30-40 years, despite all of the new therapies, relapse rates haven't really changed. I think this will really change with more widespread use of rituximab.

More reports from ACR 2015