In ANCA-associated vasculitis (granulomatosis with polyangiitis), which combination regimen is recommended for remission induction in organ-threatening or life-threatening disease according to EULAR/ERA 2022 guidelines?

• A Methotrexate plus low-dose prednisolone
• B Rituximab or cyclophosphamide plus high-dose glucocorticoids ✓
• C Mycophenolate mofetil plus high-dose glucocorticoids
• D Azathioprine plus high-dose glucocorticoids

Explanation

EULAR/ERA 2022 guidelines recommend rituximab (especially for relapsing disease or anti-GBM overlap) or cyclophosphamide combined with high-dose glucocorticoids as standard induction therapy for organ-threatening ANCA-associated vasculitis. The RITUXVAS and RAVE trials demonstrated non-inferiority of rituximab to cyclophosphamide. Methotrexate is used only for non-severe localised disease. Mycophenolate mofetil is a maintenance option but is inferior to cyclophosphamide for induction. Azathioprine is a maintenance, not induction, agent.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.