New trials, therapies to address unmet needs in ANCA-associated vasculitis
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SAN DIEGO — The future of ANCA-associated vasculitis management appears promising, as upcoming therapies will likely address current unmet needs, according to a speaker at the 2023 Congress of Clinical Rheumatology West.
Specifically, recent trials have demonstrated potential solutions for glucocorticoid-sparing, reduced time to remission and well-controlled disease for patients with AAV.
“I think I showed you data from randomized trials that address all these unmet needs, or at least they are trying to address these unmet needs,” Peter A. Merkel, MD, MPH, director of the Penn Vasculitis Center at the Perelman School of Medicine, at the University of Pennsylvania, told attendees. “There are other trials going on. There are a lot of things going on in the field to try to advance the field further.”
Referencing two studies, MAINRITSAN and RITAZAREM, Merkel explained that rituximab (Rituxan, Genentech) has a “firmly established” role in AAV remission maintenance.
“I think results of our trials firmly establish rituximab in the maintenance of remission,” he said. “PEXIVAS does not support the routine use of plasma exchange.”
In addition, there are data to support the practice of combining different immunomodulatory therapies to treat AAV.
“There are supportive data and controversy about combining immunomodulatory therapy, and we are already doing that,” Merkel said. “Don’t forget that glucocorticoids are immunosuppressive therapies.
“I think more trials will give us more effective therapies and better guidance,” he added.
Looking toward the future of AAV care, Merkel predicted more conversation surrounding glucocorticoid-sparing therapies, more ways to use B-cell depletion and more information regarding T cells.
“I think we are going to hear more about glucocorticoids, I think we are going to know more about complement inhibition,” he said. “I think we are going to hear about new ways to think about B-cell depletion — there are lots of different ways.
“We are going to think about T-cells,” he added, noting that topline data regarding abatacept (Orencia, Bristol Myers Squibb) in AAV should be arriving in the following weeks.
In the meantime, as rheumatologists await additional data and new therapies to treat AAV, Merkel stressed the importance of practicing personalized medicine.
“The thing about personalized medicine is that every one of you does personalized medicine in your office,” he said.
Assessing full histories and paying close attention to every individual patient allows physicians to make more educated and impactful decision for every patient, he added.
“We need better markers in order to decide who to start, who to stop, when to start and when to not,” Merkel said. “There is a lot of stuff coming to help us think about how to treat these patients better.”
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Merkel P. Update on ANCA-associated vasculitis. Presented at The Congress of Clinical Rheumatology West; Sept. 7-10, 2023 (hybrid meeting).
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