Hallmark trials in ANCA-associated vasculitis (AAV) for the pediatric rheumatologist

Pediatr Rheumatol Online J. 2019 Jun 26;17(1):31. doi: 10.1186/s12969-019-0343-4.

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) refers to a complex group of systemic vasculitides that are characterized by primary small-to-medium sized blood vessel inflammation with the presence of autoantibodies known as ANCA. AAV diseases include Granulomatosis with Polyangiitis (GPA), Eosinophilic Granulomatosis with Polyangiitis (EGPA), and Microscopic Polyangiitis (MPA). AAVs are challenging conditions associated with high cumulative disease and treatment related morbidity and mortality. Given its rarity and the resulting paucity of pediatric-specific clinical trial evidence, pediatric rheumatologists have had to often extrapolate from adult literature for management and therapeutic decisions. The aim of this review is to provide a comprehensive overview of the important findings and overall conclusions of critical landmark clinical trials in the induction and maintenance treatments in adult AAV for the pediatric rheumatologist. This review also highlights the outcomes of recent pediatric AAV observational studies and discusses the future research priorities in pediatric AAV management.

Keywords: Anti-neutrophil cytoplasmic antibody-associated Vasculitis; Management; Pediatric; Vasculitis.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / therapy*
  • Azathioprine / therapeutic use
  • Child
  • Churg-Strauss Syndrome / therapy
  • Cyclophosphamide / therapeutic use
  • Drug Substitution
  • Drug Therapy, Combination
  • Forecasting
  • Glucocorticoids / therapeutic use
  • Granulomatosis with Polyangiitis / therapy
  • Humans
  • Leflunomide / therapeutic use
  • Methotrexate / therapeutic use
  • Mycophenolic Acid / therapeutic use
  • Plasma Exchange / methods*
  • Prednisone / therapeutic use
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Retrospective Studies
  • Rituximab / therapeutic use
  • Severity of Illness Index

Substances

  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Rituximab
  • Cyclophosphamide
  • Leflunomide
  • Mycophenolic Acid
  • Azathioprine
  • Prednisone
  • Methotrexate