Advances in therapeutic treatment options for ANCA-associated vasculitis

Introduction: ANCA-associated vasculitis (AAV) is a group of life-threatening autoimmune conditions that require a combination of treatments for induction and maintenance therapy. High-dose glucocorticoids and cyclophosphamide have traditionally been the mainstay of AAV treatment. During the last decade, rituximab has proven to be an effective alternative to cyclophosphamide. Currently, significant research in alternative therapeutic options for both induction and maintenance treatment is underway. Areas covered: Guideline review of remission, induction, and maintenance therapy of AAV. Examination of current research on alternative advanced therapeutics, specifically, the evidence for rituximab, C5a inhibitors, and trimethoprim-sulfamethoxazole. Expert opinion: Toxicities of existing therapies for AAV need to be limited, with alternative methods and agents for induction and maintenance. Importantly, the side-effects of high dose and long-term steroids have now been recognized. Newer induction agents and maintenance regimes will lead the future of AAV treatment.