Determining the optimal duration of treatment for antineutrophil cytoplasmic antibodyassociated systemic vasculitides. When can therapy be discontinued?

Abstract

Antineutrophil cytoplasmic antibody-associated systemic vasculitides (AAV) are a group of severe, potentially fatal autoimmune diseases that include granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. The introduction of a modern therapeutic strategy based on the principles of remission induction and maintenance has fundamentally changed the prognosis of AAV, transforming them from fatal diseases into chronic relapsing disorders. A key unresolved issue is determining the optimal duration of treatment in such patients, which should balance minimization of relapse risk against reduction of the cumulative toxicity of long-term immunosuppression. Based on data from randomized clinical trials, meta-analyses, and international clinical guidelines, this review discusses the most appropriate duration of therapy at the remission induction and maintenance stages. Particular attention is paid to the principles of a personalized approach involving relapse risk stratification.