Polymyalgia rheumatica — SCE Rheumatology MCQ

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HardVasculitisPolymyalgia rheumaticaSCE Rheumatology

A patient has severe active MPO-ANCA microscopic polyangiitis with rapidly progressive glomerulonephritis. Avacopan is proposed to reduce glucocorticoid exposure. Which statement matches NICE TA825?

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Correct answer: C — Avacopan with rituximab or cyclophosphamide induction

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

A is correct. NICE recommends avacopan as an option for severe active GPA or MPA in combination with a rituximab- or cyclophosphamide-based regimen. It can reduce conventional glucocorticoid exposure but does not replace remission-induction immunosuppression. B turns adjunctive treatment into unsafe monotherapy. C invents a non-inflammatory indication. D gives an unsupported TNF restriction. E ignores the licensed treatment phase and individual maintenance planning. Infection prophylaxis, renal trajectory and the residual glucocorticoid requirement remain part of induction care.

Reference: NICE TA825: avacopan for severe active granulomatosis with polyangiitis or microscopic polyangiitis: https://www.nice.org.uk/guidance/ta825/chapter/1-Recommendations