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AAV Immunosuppression Withdrawal Factors MPO — ESENeph MCQ

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ModerateRenal VasculitisAAV Immunosuppression Withdrawal Factors MPOESENeph

A 50-year-old man with ANCA-associated vasculitis has been in remission on rituximab maintenance for 4 years. His MPO-ANCA has been negative for 2 years. He wishes to stop immunosuppression. What factors favour a trial of immunosuppression withdrawal?

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Correct answer: D — MPO-ANCA specificity, sustained remission >2 years, and low-damage state

Factors favouring a trial of immunosuppression withdrawal in AAV include: MPO-ANCA specificity (lower relapse rate than PR3-ANCA), sustained remission >2 years (ideally >4 years on maintenance), persistently negative ANCA, low Birmingham Vasculitis Activity Score, and absence of prior relapses. PR3-ANCA disease has a significantly higher relapse rate (50-70% vs 20-30% for MPO-ANCA). KDIGO 2024 AAV guidelines recommend at least 24 months of maintenance but acknowledge that some patients can safely stop after prolonged remission with close monitoring. Withdrawal should be gradual (not abrupt) with frequent clinical and serological monitoring (ANCA, CRP, urinalysis, eGFR) every 1-3 months for at least 2 years.

Reference: KDIGO 2024 – AAV Guideline; Walsh et al 2012 – Relapse Predictors AAV