319. 2022 EULAR recommendations for the management of ANCA-associated vasculitis (AAV): methods & project update

Background/ Objectives: The 2008 and 2016 European Alliance of Associations for Rheumatology (EULAR) recommendations for the management of AAV (GPA, MPA and EGPA) ^1,2 have provided guidance for management, monitoring, and treatment of AAV in daily practice and are highly cited. The publication of several high-impact research articles in the past 5 years including landmark studies on the role of plasma exchange, standardization of glucocorticoid dosing, use of rituximab for maintenance therapy, C5a receptor targeted therapy and anti-IL5 therapy in EGPA make this an opportune time to update the 2016 guidelines.

Methods: The recommendations will be developed based on an evidence-based approach as outlined in the 2014 EULAR standardized operating procedures³. The systematic literature review (SLR) will be restricted to a keyword search of Medline, Embase and the Cochrane Central databases of topics identified through a Delphi process and those from the 2016 recommendations. Key questions will be framed in the PICO (Population, Intervention, Comparator, Outcome) format. The literature search will be restricted to March 2015 for updated domains but unrestricted for new domains. All types of studies with 10 patients or more will be included. Abstracts of the annual meetings of EULAR, ACR, ERA-EDTA, ASN and the Vasculitis and ANCA Workshops will also be screened, but restricted to randomized controlled clinical trials (RCTs). The number of manuscripts in each category will be described (for example RCTs, prospective versus retrospective studies etc.). The Cochrane revised tool for assessing risk of bias for RCTs (RoB2), ROBINS-1 for observational studies, QUADAS II for studies on accuracy of diagnostic tests and ATAR II for meta-analyses will be used for bias assessment. A summary of findings tables will be created according to the PICO format. When there is need to evaluate treatment modalities, we will consider the need to quantify the treatment effects. When comparing clinical trials, we will give greater weight to outcome measures, which have been validated. Evidence will be categorized based on the GRADE system  and the strength of each recommendation will be assigned as per EULAR standardized operating procedures². The recommendations will be developed by a group of experts from several medical disciplines including rheumatology, nephrology and internal medicine, other health care essionals and patient partners from 17 different countries. For recommendation statements, which are not derived from homogenously conducted clinical trials, we will attempt to formulate consensus based clinical recommendations. These will be clearly labelled as arising from an expert opinion approach and these statements will have a default strength of D. The recommendations will be validated independently by a vote amongst the membership of the EUVAS following the Appraisal of Guidelines for Research and Evaluation Version II (AGREE II) instrument. The final set of recommendations will be submitted for the scrutiny of the EULAR clinical affairs committee.

Results: The application to update the recommendations has been approved by EULAR and the SLR is ongoing. Publication of the final recommendations is expected at the end of 2022.

Conclusions: In view of recent fundamental developments affecting key areas of management of AAV, we believe that the 2016 recommendations no longer reflect current standard of management and therefore will now be updated.

References

1. Mukhtyar C, et al. EULAR Recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis. 2008;68:310-317.

1. Yates M et al.  EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. 2016 Sep;75(9):1583-94
2. van der Heijde D et al. 2014 Update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann Rheum Dis. 2015 Jan;74(1):8-13.

Disclosures: The project is funded by the EULAR. All authors report no other conflicts of interest related to the content of this abstract