Pan American League of Associations for Rheumatology Guidelines for the treatment of ANCA-associated vasculitis

Magri S.J.; Ugarte-Gil M.F.; Brance M.L.; Flores-Suárez L.F.; Fernández-Ávila D.G.; Scolnik M.; Sato E.I.; de Souza A.W.S.; Saldarriaga-Rivera L.M.; Babini A.M.; Zamora N.V.; Felquer M.L.A.; Vergara F.; Carlevaris L.; Scarafia S.; Guppy E.R.S.; Unizony S. · The Lancet Rheumatology (2023) · DOI: 10.1016/s2665-9913(23)00128-5

Resumen

Considerable variability exists in the way health-care providers treat patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in Latin America. The most frequently used treatments for ANCA-associated vasculitis are cyclophosphamide and prolonged glucocorticoid tapers; however, randomised controlled trials conducted over the past 30 years have led to the development of several evidence-based treatment alternatives for these patients. Latin America faces socioeconomic challenges that affect access to care, and the use of certain costly medications with proven efficacy ANCA-associated vasculitis is often restricted. For these reasons, the Pan American League of Associations for Rheumatology developed the first ANCA-associated vasculitis treatment guidelines tailored for Latin America. A panel of local vasculitis experts generated clinically meaningful questions related to the treatment of ANCA-associated vasculitis using the Population, Intervention, Comparator, and Outcome (PICO) format. Following the Grading of Recommendations Assessment, Development, and Evaluation methodology, a team of methodologists conducted a systematic literature review. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members. 21 recommendations and two expert opinion statements for the treatment of ANCA-associated vasculitis were developed, considering the current evidence and the socioeconomic characteristics of the region. These recommendations include guidance for the use of glucocorticoids, non-glucocorticoid immunosuppressants, and plasma exchange.

Instituciones: Universidad Científica del Sur