MYCYC: unravelling the long road ahead in ANCA-associated vasculitis

Abstract

Non-reversibility of renal dysfunction with immunosuppressive therapy raises a suspicion of a component of chronicity to the underlying renal disease. Since patients with recent decline (eGFR fall >20%) in renal function in previous 2 weeks were excluded, the baseline renal dysfunction at entry could be reflective of previously unrecognised or relapsing/refractory renal disease. [...]although newly diagnosed (within 6 months) patients were included in the trial, it might be prudent to examine the duration of disease (taken from onset of first AAV- related symptom) at the time of recruitment. [...]with a statistically significant increase in relapse rates in the MMF arm after 18 months of follow-up in the current study, it would be interesting to see if the long-term outcome of this cohort of patients parallels the NORAM trial.7 8 With the still uncertain way of handling steroids during induction and maintenance of AAV and the expanding therapeutic armamentarium for AAV, these certainly are challenging although exciting times in the management of AAV.