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New EULAR/EDTA Recommendations for the Management of AAV
June 9 2016 10:42 PM ET — via RheumReports
Max Yates presented an update to the 2009 EULAR recommendations for the management of primary and small vessel vasculitis on Thursday morning at EULAR in London.
These are the result of a joint effort between EULAR and the European Renal Association (EDTA) involving 21 experts from Europe and America who conducted a Delphi exercise to guide areas needing update. Data from January 2007 to February 2015 were included in a systematic literature review and GRADE methodology was utilized for voting. To further validate the results, the voting process was repeated amongst the members of EUVAS.
The 15 recommendations were updated to include choice of drug therapy (for induction and remission therapy), monitoring for complications, utility of repeat biopsy in relapsing disease, monitoring for hypogammaglobulinemia and other useful clinical questions. They also developed a supplement which includes an audit tool (to allow us to audit our clinical practice), modules on eye disease and ENT disease, and a bank of all the clinical trial data included.
With regards to treatment, they classified patients based on disease severity. In patients with life- or organ-threatening disease, the authors recommend induction with cyclophosphamide or rituximab plus glucocorticoids. Once remission is achieved, patients can stepped down to AZA, MTX or RIT. After 2 years of prolonged remission off GCs with no relapse, then the AZA, MTX or RIT can be completely tapered off slowly. They also recommend use of plasma exchange in patients with rapidly progressive renal failure or severe diffuse pulmonary hemorrhage.
In patients with non-life-threatening disease, they recommend use of GCs with MTX, AZA or RIT with slow taper after prolonged remission (> 2 years) off GCs without relapse.
There was a strong emphasis on minimizing the dose of GC use in all patients.
Overall, these recommendations appear to be very practical for clinical practice. Although the speaker did not show the supplement, I am interested in seeing the modules on ENT and eye disease, as these can be clinically challenging to diagnose and manage.
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About the Author
Dr. Shahin Jamal
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.
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