AAV Maintenance Duration — SCE Rheumatology MCQ

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ModerateVasculitisAAV Maintenance DurationSCE Rheumatology

A 55-year-old man with newly diagnosed granulomatosis with polyangiitis has achieved remission following induction treatment and is commencing remission-maintenance therapy. According to the 2025 British Society for Rheumatology recommendations, which statement best describes the usual duration of maintenance treatment?

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Correct answer: D — Continue for 24–48 months after remission, considering longer treatment when relapse risk is high

The correct answer is D. For granulomatosis with polyangiitis or microscopic polyangiitis, the 2025 BSR recommendations support continuing remission-maintenance treatment for 24–48 months after remission. Longer treatment may be appropriate when relapse risk is high, particularly with relapsing disease or a PR3-ANCA phenotype, but this must be balanced against infection and treatment-toxicity risks and patient preferences. Twelve months is generally too short, while routine lifelong treatment is not recommended for every patient. Three- and six-month courses are inadequate maintenance durations. The recommendation applies specifically to GPA and MPA; the original generic term “ANCA vasculitis” was insufficient because eosinophilic granulomatosis with polyangiitis has a distinct maintenance-treatment framework.

Reference: British Society for Rheumatology, The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis, GPA and MPA treatment recommendations, 2025. https://pubmed.ncbi.nlm.nih.gov/40499922/