2024年版KDIGO《ANCA相关性血管炎管理临床实践指南》更新重点内容解读

Interpretation of updated key content of 2024 KDICO Clinical Practice Guideline for the Management of ANCAAssociatedVasculitis

2024年版KDIGO《ANCA相关性血管炎管理临床实践指南》最重要的更新内容与诱导治疗有关,即口服C5a受体拮抗剂avacopan可有效替代糖皮质激素治疗抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV),并有可能改善肾脏预后。对于AAV重叠抗肾小球基底膜(GBM)病的患者,需要血浆置换治疗。该版指南更新中未改变维持治疗方案,但是提及利妥昔单抗治疗的最佳持续时间为缓解诱导后的18个月至4年,可以根据固定时间表或CD19+B细胞和(或)ANCA的重新出现来计量。对于具有复发或难治性疾病的AAV患者或肾移植后的患者,该版指南的内容没有更新。

The most significant updates in 2024 version of"KDICO Clinical Practice Guideline for the Management of ANCA-Associated Vasculitis"are related to induction therapy.Avacopan,an oral C5a receptor antagonist,is an effective substitute for glucocorticoids in the treatment of ANCA-associated AAV,and may improve renal outcomes.For patients with AAV overlapped with anti-glomerularbasementmembrane(CBM)disease,plasma exchange therapy is required.Maintenance therapy is not changed in this guideline updates;for rituximab,the updated guidelines now mention that the optimal duration of treatment is 18 months to 4 years after induction of remission,and rituximab can be measured based on a fixed schedule or the reemergence of CD19*B cells and/or ANCA.There is no change in this guidelines concerning the content of AAV patients with relapsing or refractory disease or those after kidney transplantation.