European Vasculitis Experts Vote on New EULAR Recommendations

Members of the U.K.-based European Vasculitis Society (EUVAS) have accepted recently published recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, EUVAS clinicians don’t necessarily agree with the recommendations’ suggestion to use Rituxan (rituximab) to treat patients who have eosinophilic granulomatosis with polyangiitis (EGPA).

The study, “Validation of the EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis by disease content experts,” appeared in the journal Rheumatic & Musculoskeletal Disease.

The European League Against Rheumatism (EULAR) recently updated its recommendations on managing small-vessel and medium-vessel vasculitides, focusing especially on treatment for AAV. A task force of specialists voted on those recommendations, but for the first time, after voting, EUVAS members graded the recommendations.

Task force specialists generally agreed with EUVAS members. The one notable dispute was over the use of Rituxan in patients with EGPA that were suffering new-onset AAV, as well as disagreement concerning maintenance therapy using methotrexate or mycophenolate mofetil.

Interestingly, in patients with non-organ, non-life threatening AAV, none of the task members voted the highest grade for using methotrexate or mycophenolate, while 35 percent of EUVAS members gave methotrexate the highest grade, and 12 percent gave mycophenolate their highest score. Furthermore, there was high concordance between EUVAS and the task force for the use of azathioprine for remission maintenance therapy in AAV, indicating that azathioprine may be a very effective drug.

The general agreement between the task force and EUVAS indicate that clinicians should widely adopt these guidelines, which derive from a survey in which experts in 29 countries participated.

The authors are unsure why the use of Rituxan in patients with EGPA received such a low grade. But they suspect it might simply be because EUVAS members are more familiar with previous guidelines, in which Rituxan was not strongly recommended.

Regarding the use of methotrexate or mycophenolate, the authors write, “This may represent a loss in confidence in these two drugs in the practicing community, as compared with the results of the clinical trials that were interpreted by the task force.”