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Novel Therapies for ANCA-associated Vasculitis

  • Vasculitis (C Dejaco and C Duftner, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to discuss the most recent evidence on the treatment innovations and future prospective in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs).

Recent Findings

In AAV, a growing body of research is available on novel treatment options for remission induction and to clarify some uncertainties concerning the optimal use of available drugs. Efforts are being made to reduce the toxicity associated with high-dose, prolonged glucocorticoids (GC) regimens. Despite major advances in the prognosis of AAV, relapses are still common and the intensity and duration of remission treatment constitute a great challenge in the management of these chronic conditions.

Summary

A paradigm shift in practice in the management of AAV is being supported by recent evidence suggesting the comparable efficacy and improved safety profile of schemes with a reduced dose of GC for the induction and maintenance of remission in patients with severe granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Moreover, recent appraisal of pathogenetic mechanisms, including complement activation pathways, has introduced the revolutionary concept of an alternative to GC, such as avacopan. Plasma exchange failed to prevent end-stage renal disease and mortality in patients with severe renal involvement or pulmonary haemorrhage according to a large multicentre randomised trial. Intensified immunosuppressive strategies for patients with life-threatening manifestations, including the combination of rituximab (RTX) with cyclophosphamide (CYC) have revealed promising preliminary data. New evidence for the use of alternative immunosuppressive agents (e.g. mycophenolate mofetil or abatacept) for the induction of remission in patients with non-severe disease is emerging. Several studies have been recently published, or are ongoing, to assess the optimal strategy and duration of maintenance of remission with the available treatment options (GC, azathioprine, and RTX). Preliminary evidence supports the superiority of a more prolonged course of maintenance treatment. The management of refractory or relapsing eosinophilic granulomatosis with polyangiitis (EGPA) has been improved by the recent demonstration of efficacy and safety of an interleukin-5 inhibitor, mepolizumab. Ongoing randomised studies will clarify the role of RTX in patients with severe manifestations of EGPA.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fauci AS, Katz P, Haynes BF, Wolff SM. Cyclophosphamide therapy of severe systemic necrotizing vasculitis. N Engl J Med. 1979;301:235–8.

    Article  CAS  PubMed  Google Scholar 

  2. Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, et al. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011;70:488–94.

    Article  PubMed  Google Scholar 

  3. Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010;363:221–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jones RB, Tervaert JWC, Hauser T, Luqmani R, Morgan MD, Peh CA, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med. 2010;363:211–20.

    Article  CAS  PubMed  Google Scholar 

  5. Lafarge A, Joseph A, Pagnoux C, Puéchal X, Cohen P, Samson M, et al. Predictive factors of severe infections in patients with systemic necrotizing vasculitides: data from 733 patients enrolled in five randomized controlled trials of the French Vasculitis Study Group. Rheumatol Oxf Engl. 2020;59:2250–7.

    Article  Google Scholar 

  6. Cornec D, Cornec-Le Gall E, Specks U. Clinical trials in antineutrophil cytoplasmic antibody-associated vasculitis: what we have learnt so far, and what we still have to learn. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2017;32:i37–47.

    CAS  Google Scholar 

  7. Monti S, Quinn KA, Christensen R, Jayne D, Langford C, Lanier GE, et al. Use and reporting of outcome measures in randomized trials for anti-neutrophil cytoplasmic antibody-associated vasculitis: a systematic literature review of randomized trials. Semin Arthritis Rheum. 2020;50:1314–25.

    Article  CAS  PubMed  Google Scholar 

  8. Furuta S, Sugiyama T, Umibe T, Kaneko Y, Amano K, Kurasawa K, et al. Low-dose glucocorticoids plus rituximab versus high-dose glucocorticoids plus rituximab for remission induction in ANCA-associated vasculitis (LoVAS): protocol for a multicentre, open-label, randomised controlled trial. BMJ Open [Internet]. 2017 [cited 2019 Oct 15];7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778278/

  9. •• Walsh M, Merkel PA, Peh C-A, Szpirt WM, Puéchal X, Fujimoto S, et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med. 2020;382:622–31 PEXIVAS opens new horizons on the management of patients with AAV by supporting the use of reduced-dose glucocorticoids and challenging the role of PLEX.

  10. • Chanouzas D, McGregor JAG, Nightingale P, Salama AD, Szpirt WM, Basu N, et al. Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated vasculitis: a multi-center retrospective cohort study. BMC Nephrol. 2019;20:–58 This study demonstrated that glucocorticoids pulses are not associated with better disease outcomes, but with a greater infections risk.

  11. Casian A, Jayne D. Plasma exchange in the treatment of Wegener’s granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and renal limited vasculitis. Curr Opin Rheumatol. 2011;23:12–7.

    Article  PubMed  Google Scholar 

  12. Jayne DRW, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol JASN. 2007;18:2180–8.

    Article  CAS  PubMed  Google Scholar 

  13. Cortazar FB, Niles JL. The fate of plasma exchange and glucocorticoid dosing in ANCA-associated vasculitis after PEXIVAS. Am J Kidney Dis Off J Natl Kidney Found. 2020;76:595–7.

    Article  CAS  Google Scholar 

  14. Morris A, Geetha D. PEXIVAS challenges current ANCA-associated vasculitis therapy. Nat Rev Nephrol. 2020;16:373–4.

  15. Dick J, Gan P-Y, Ford SL, Odobasic D, Alikhan MA, Loosen SH, et al. C5a receptor 1 promotes autoimmunity, neutrophil dysfunction and injury in experimental anti-myeloperoxidase glomerulonephritis. Kidney Int. 2018;93:615–25.

    Article  CAS  PubMed  Google Scholar 

  16. Kallenberg CGM, Heeringa P. Complement system activation in ANCA vasculitis: a translational success story? Mol Immunol. 2015;68:53–6.

    Article  CAS  PubMed  Google Scholar 

  17. Quintana LF, Kronbichler A, Blasco M, Zhao M-H, Jayne D. ANCA associated vasculitis: the journey to complement-targeted therapies. Mol Immunol. 2019;112:394–8.

    Article  CAS  PubMed  Google Scholar 

  18. Deshayes S, Aouba A, Khoy K, Mariotte D, Lobbedez T, Martin SN. Hypocomplementemia is associated with worse renal survival in ANCA-positive granulomatosis with polyangiitis and microscopic polyangiitis. PLoS One. 2018;13:e0195680.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Manenti L, Vaglio A, Gnappi E, Maggiore U, Allegri L, Allinovi M, et al. Association of serum C3 concentration and histologic signs of thrombotic microangiopathy with outcomes among patients with ANCA-associated renal vasculitis. Clin J Am Soc Nephrol CJASN. 2015;10:2143–51.

    Article  CAS  PubMed  Google Scholar 

  20. •• Jayne DRW, Bruchfeld AN, Harper L, Schaier M, Venning MC, Hamilton P, et al. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J Am Soc Nephrol JASN. 2017;28:2756–67 First study to report the efficacy of avacopan and introducing the concept of an alternative to glucocorticoids in the management of AAV.

    Article  CAS  PubMed  Google Scholar 

  21. Merkel PA, Niles J, Jimenez R, Spiera RF, Rovin BH, Bomback A, et al. Adjunctive treatment with avacopan, an oral C5a receptor inhibitor, in patients with antineutrophil cytoplasmic antibody-associated vasculitis. ACR Open Rheumatol. 2020;2:662–71.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Merkel PA, Jayne DR, Wang C, Hillson J, Bekker P. Evaluation of the safety and efficacy of avacopan, a C5a receptor inhibitor, in patients with antineutrophil cytoplasmic antibody-associated vasculitis treated concomitantly with rituximab or cyclophosphamide/azathioprine: protocol for a randomized, double-blind, active-controlled, phase 3 trial. JMIR Res Protoc. 2020;9:e16664.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moura MC, Irazabal MV, Eirin A, Zand L, Sethi S, Borah BJ, et al. Efficacy of rituximab and plasma exchange in antineutrophil cytoplasmic antibody–associated vasculitis with severe kidney disease. J Am Soc Nephrol. 2020;31:2688–704.

    Article  CAS  Google Scholar 

  24. Cortazar FB, Muhsin SA, Pendergraft WF, Wallace ZS, Dunbar C, Laliberte K, et al. Combination therapy with rituximab and cyclophosphamide for remission induction in ANCA vasculitis. Kidney Int Rep. 2018;3:394–402.

    Article  PubMed  Google Scholar 

  25. McAdoo SP, Medjeral-Thomas N, Gopaluni S, Tanna A, Mansfield N, Galliford J, et al. Long-term follow-up of a combined rituximab and cyclophosphamide regimen in renal anti-neutrophil cytoplasm antibody-associated vasculitis. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2019;34:63–73.

    CAS  Google Scholar 

  26. McClure M, Gopaluni S, Jayne D, Jones R. B cell therapy in ANCA-associated vasculitis: current and emerging treatment options. Nat Rev Rheumatol. 2018;14:580–91.

    Article  PubMed  Google Scholar 

  27. • Jones RB, Hiemstra TF, Ballarin J, Blockmans DE, Brogan P, Bruchfeld A, et al. Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis: a randomised, non-inferiority trial. Ann Rheum Dis. 2019;78:399–405 Supports the role of mycophenolate as induction of remission strategy for AAV.

    Article  CAS  PubMed  Google Scholar 

  28. Tuin J, Stassen PM, Bogdan DI, Broekroelofs J, van Paassen P, Cohen Tervaert JW, et al. Mycophenolate mofetil versus cyclophosphamide for the induction of remission in nonlife-threatening relapses of antineutrophil cytoplasmic antibody-associated vasculitis: randomized, controlled trial. Clin J Am Soc Nephrol CJASN. 2019;14:1021–8.

    Article  CAS  PubMed  Google Scholar 

  29. Langford CA, Monach PA, Specks U, Seo P, Cuthbertson D, McAlear CA, et al. An open-label trial of abatacept (CTLA4-IG) in non-severe relapsing granulomatosis with polyangiitis (Wegener’s). Ann Rheum Dis. 2014;73:1376–9.

    Article  CAS  PubMed  Google Scholar 

  30. Berti A, Cavalli G, Campochiaro C, Guglielmi B, Baldissera E, Cappio S, et al. Interleukin-6 in ANCA-associated vasculitis: rationale for successful treatment with tocilizumab. Semin Arthritis Rheum. 2015;45:48–54.

    Article  CAS  PubMed  Google Scholar 

  31. Sakai R, Ito M, Yoshimoto K, Chikuma S, Kurasawa T, Kondo T, et al. Tocilizumab monotherapy uncovered the role of the CCL22/17-CCR4+ Treg axis during remission of crescentic glomerulonephritis. Clin Transl Immunol. 2020;9:e1203.

    Article  CAS  Google Scholar 

  32. Sakai R, Kondo T, Kikuchi J, Shibata A, Chino K, Okuyama A, et al. Corticosteroid-free treatment of tocilizumab monotherapy for microscopic polyangiitis: a single-arm, single-center, clinical trial. Mod Rheumatol. 2016;26:900–7.

    Article  CAS  PubMed  Google Scholar 

  33. JPRN-JMA-IIA00325. Clinical trial of tocilizumab versus cyclophosphamide for microscopic polyangiitis and granulomatosis with polyangiitis. Httpwwwwhointtrialsearchtrial2aspx Trialidjprn-Jma-Iia00325 [Internet]. 2019 [cited 2019 Jun 8]; Available from: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01901006/full

  34. Shimizu T, Morita T, Kumanogoh A. The therapeutic efficacy of intravenous immunoglobulin in anti-neutrophilic cytoplasmic antibody-associated vasculitis: a meta-analysis. Rheumatol Oxf Engl. 2020;59:959–67.

    Article  CAS  Google Scholar 

  35. Springer J, Nutter B, Langford CA, Hoffman GS, Villa-Forte A. Granulomatosis with polyangiitis (Wegener’s): impact of maintenance therapy duration. Medicine (Baltimore). 2014;93:82–90.

    Article  CAS  Google Scholar 

  36. •• Karras A, Pagnoux C, Haubitz M, Groot K, de Puechal X, Tervaert JWC, et al. Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis. Ann Rheum Dis. 2017;76:1662–8 Supports the efficacy and safety of a more prolonged remission maintenance treatment with azathioprine.

    Article  CAS  PubMed  Google Scholar 

  37. Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, Cohen P, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med. 2014;371:1771–80.

    Article  PubMed  Google Scholar 

  38. •• Terrier B, Pagnoux C, Perrodeau É, Karras A, Khouatra C, Aumaître O, et al. Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides. Ann Rheum Dis. 2018;77:1150–6 Supports the efficacy and safety of a more prolonged remission maintenance treatment with rituximab.

    Article  PubMed  Google Scholar 

  39. Charles P, Terrier B, Perrodeau É, Cohen P, Faguer S, Huart A, et al. Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2). Ann Rheum Dis. 2018;77:1143–9.

    Article  PubMed  Google Scholar 

  40. Charles P, Perrodeau É, Samson M, Bonnotte B, Néel A, Agard C, et al. Long-term rituximab use to maintain remission of antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med. 2020;173:179–87.

    Article  PubMed  Google Scholar 

  41. Smith R, Jayne D, Merkel PA, on behalf of RITAZAREM Investigators. OP0026 a randomized, controlled trial of rituximab versus azathioprine after induction of remission with rituximab for patients with ANCA-associated vasculitis and relapsing disease. Ann Rheum Dis. 2020;79:19–20.

    Article  Google Scholar 

  42. Jayne D, Blockmans D, Luqmani R, Moiseev S, Ji B, Green Y, et al. Efficacy and safety of belimumab and azathioprine for maintenance of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized controlled study. Arthritis Rheumatol Hoboken NJ. 2019;71:952–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. 2016;75:1583–94.

    Article  CAS  PubMed  Google Scholar 

  44. •• Gopaluni S, Smith RM, Lewin M, McAlear CA, Mynard K, Jones RB, et al. Rituximab versus azathioprine as therapy for maintenance of remission for anti-neutrophil cytoplasm antibody-associated vasculitis (RITAZAREM): study protocol for a randomized controlled trial. Trials. 2017;18:112 Supports the efficacy and safety of rituximab for the induction and maintenance of remission in AAV.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Walsh M, Merkel PA, Mahr A, Jayne D. Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: a meta-analysis. Arthritis Care Res. 2010;62:1166–73.

    Article  Google Scholar 

  46. Pinching AJ, Rees AJ, Pussell BA, Lockwood CM, Mitchison RS, Peters DK. Relapses in Wegener’s granulomatosis: the role of infection. Br Med J. 1980;281:836–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Stegeman CA, Tervaert JW, Sluiter WJ, Manson WL, de Jong PE, Kallenberg CG. Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis. Ann Intern Med. 1994;120:12–7.

    Article  CAS  PubMed  Google Scholar 

  48. Salmela A, Rasmussen N, Tervaert JWC, Jayne DRW, Ekstrand A, European Vasculitis Study Group. Chronic nasal Staphylococcus aureus carriage identifies a subset of newly diagnosed granulomatosis with polyangiitis patients with high relapse rate. Rheumatol Oxf Engl. 2017;56:965–72.

    Article  CAS  Google Scholar 

  49. DeRemee RA. The treatment of Wegener’s granulomatosis with trimethoprim/sulfamethoxazole: illusion or vision? Arthritis Rheum. 1988;31:1068–74.

    Article  CAS  PubMed  Google Scholar 

  50. Fukuda K, Yuasa K, Uchizono A, Matsuyama H, Shimada K, Ohyama M. Three cases of Wegener’s granulomatosis treated with an antimicrobial agent. Arch Otolaryngol Head Neck Surg. 1989;115:515–8.

    Article  CAS  PubMed  Google Scholar 

  51. Reinhold-Keller E, De Groot K, Rudert H, Nölle B, Heller M, Gross WL. Response to trimethoprim/sulfamethoxazole in Wegener’s granulomatosis depends on the phase of disease. QJM Mon J Assoc Physicians. 1996;89:15–23.

    Article  CAS  Google Scholar 

  52. Zycinska K, Wardyn KA, Zielonka TM, Krupa R, Lukas W. Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement. Eur J Med Res. 2009;14(Suppl 4):265–7.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Stegeman CA, Tervaert JW, de Jong PE, Kallenberg CG. Trimethoprim-sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Wegener’s granulomatosis. Dutch Co-Trimoxazole Wegener Study Group. N Engl J Med. 1996;335:16–20.

    Article  CAS  PubMed  Google Scholar 

  54. Tan BK, Crabol Y, Tasse J, Laurent F, Nekkab N, Vinter C, et al. No evident association of nasal carriage of Staphylococcus aureus or its small-colony variants with cotrimoxazole use or ANCA-associated vasculitis relapses. Rheumatol Oxf Engl. 2020;59:77–83.

    Article  Google Scholar 

  55. Berti A, Specks U, Keogh K, Cornec D. Current and future treatment options for eosinophilic granulomatosis with polyangiitis. Curr Treat Options Rheumatol. 2017;3:1–14.

    Google Scholar 

  56. •• Wechsler ME, Akuthota P, Jayne D, Khoury P, Klion A, Langford CA, et al. Mepolizumab or placebo for eosinophilic granulomatosis with polyangiitis. N Engl J Med. 2017;376:1921–32 First trial to demonstrate the efficacy of mepolizumab in EGPA leading to the first targeted-treatment for EGPA.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Steinfeld J, Bradford ES, Brown J, Mallett S, Yancey SW, Akuthota P, et al. Evaluation of clinical benefit from treatment with mepolizumab for patients with eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol. 2019;143:2170–7.

    Article  CAS  PubMed  Google Scholar 

  58. Guillevin L. Mepolizumab for eosinophilic granulomatosis with polyangiitis. Nat Rev Rheumatol Nature Publishing Group. 2017;13:518–9.

    Article  CAS  PubMed  Google Scholar 

  59. Ennis D, Lee JK, Pagnoux C. Mepolizumab for the treatment of eosinophilic granulomatosis with polyangiitis. Expert Opin Biol Ther. 2019;19:617–30.

    Article  CAS  PubMed  Google Scholar 

  60. Bettiol A, Urban ML, Alberici F, Agostini C, Baldini C, Bozzolo E, et al. Op0148 Mepolizumab for eosinophilic granulomatosis with polyangiitis (egpa): a retrospective real-world European study on 142 patients. Ann Rheum Dis BMJ Publishing Group Ltd. 2020;79:94–5.

    Article  Google Scholar 

  61. Detoraki A, Di Capua L, Varricchi G, Genovese A, Marone G, Spadaro G. Omalizumab in patients with eosinophilic granulomatosis with polyangiitis: a 36-month follow-up study. J Asthma Off J Assoc Care Asthma. 2016;53:201–6.

    Article  CAS  Google Scholar 

  62. Jachiet M, Samson M, Cottin V, Kahn J-E, Le Guenno G, Bonniaud P, et al. Anti-IgE monoclonal antibody (omalizumab) in refractory and relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss): data on seventeen patients. Arthritis Rheum Hoboken NJ. 2016;68:2274–82.

    Article  CAS  Google Scholar 

  63. Celebi Sozener Z, Gorgulu B, Mungan D, Sin BA, Misirligil Z, Aydin O, et al. Omalizumab in the treatment of eosinophilic granulomatosis with polyangiitis (EGPA): single-center experience in 18 cases. World Allergy Organ J. 2018;11:39.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Nazir S, Tachamo N, Fareedy SB, Khan MS, Lohani S. Omalizumab-associated eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2017;118:372–374.e1.

    Article  Google Scholar 

  65. Basta F, Mazzuca C, Nucera E, Schiavino D, Afeltra A, Antonelli IR. Omalizumab in eosinophilic granulomatosis with polyangiitis: friend or foe? A systematic literature review. Clin Exp Rheumatol. 2020;38(Suppl 124):214–20.

    PubMed  Google Scholar 

  66. Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry M-J, Amudala N, et al. Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Ann Rheum Dis. 2016;75:396–401.

    Article  CAS  PubMed  Google Scholar 

  67. Teixeira V, Mohammad AJ, Jones RB, Smith R, Jayne D. Efficacy and safety of rituximab in the treatment of eosinophilic granulomatosis with polyangiitis. RMD Open. 2019;5:e000905.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. BMJ Publishing Group Ltd. 2016;75:1583–94.

    CAS  Google Scholar 

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Monti, S., Brandolino, F., Milanesi, A. et al. Novel Therapies for ANCA-associated Vasculitis. Curr Rheumatol Rep 23, 38 (2021). https://doi.org/10.1007/s11926-021-01010-0

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