GPA Subglottic Stenosis — ESENeph MCQ

Correct answer: C — Avacopan with rituximab induction

The best answer is “Avacopan with rituximab induction”. NICE recommends avacopan with cyclophosphamide or rituximab for adults with severe active GPA or MPA. It complements standard induction and can reduce glucocorticoid toxicity; it does not replace remission-induction immunosuppression. “Avacopan as isolated monotherapy without rituximab or cyclophosphamide” is less appropriate because NICE positions avacopan alongside a standard induction regimen, not as a substitute for it “Caplacizumab alongside rituximab” is less appropriate because caplacizumab treats acquired TTP rather than ANCA-associated vasculitis “Imlifidase as chronic vasculitis therapy” is less appropriate because imlifidase is used for selected transplant desensitisation “Lumasiran as complement-pathway treatment” is less appropriate because lumasiran treats primary hyperoxaluria type 1

Reference: NICE TA825: avacopan for severe active AAV: https://www.nice.org.uk/guidance/TA825/chapter/1-Recommendations