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

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.
Competing Interests: Declaration of interests Several authors of these guidelines, including voting members, have interacted with the pharmaceutical industry including the manufacturers of some of the drugs mentioned in these recommendations. However, none of the authors received any support or fee directly or indirectly related to or influencing the development of these guidelines. SJM reports being a speaker for, consulting for, and receiving research support from Roche, Pfizer, AbbVie, Janssen, Sandoz, and GlaxoSmithKline. MFU-G reports being a speaker for and receiving research support and consulting fees from Janssen, AstraZeneca, GlaxoSmithKline, AbbVie, and Pfizer. LFF-S reports being a speaker for and doing medical writing for the American College of Rheumatology, Sociedad Española de Reumatología, Editorial Médica Panamericana, and Elsevier. DGF-Á reports being a speaker for Amgen, Janssen, Novartis, Eli Lilly, and Pfizer; and receiving support for attending meetings from Janssen. MS reports being a speaker for, consulting for, and receiving research support from AbbVie, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Eli Lilly, Pfizer, Roche, and AstraZeneca. EIS reports consulting for Janssen. AWSdS reports being on the advisory board of Vifor Pharma. LMS-R reports being a speaker for, consulting for, and being on the advisory board of Novartis, Pfizer, Janssen, Roche, and Eli Lilly. AMB reports being a speaker for and consulting for AbbVie, GlaxoSmithKline, Janssen, Pfizer, Boehringer-Ingelheim, and Bristol-Myers Squibb. ERSG reports being a speaker for, consulting for, and receiving research support from AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and Sandoz. SU reports consulting for and receiving research support from Kiniksa, Janssen, Genentech, GlaxoSmithKline, and Sanofi. All other authors declare no competing interests.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)