Vasculitis highlights from the American College of Rheumatology Annual Meeting, Chicago, 24-29 October 2025
SELECT-GCA Period 2 (52-104 weeks) trial outcomes: Compared a strategy of continuing or stopping Upadacitinib in GCA patients in remission at 52 weeks. Patients were more likely to maintain remission and less likely to flare if they continued on Upadacitinib 15 mg daily (flare rate 16%) than if they swapped to placebo (flare rate 66%). These results echo the experience with Tocilizumab in GCA whereby drug withdrawal at 52 weeks is associated with high relapse rates.
MAINRITSEG trial outcomes. Compared a strategy of Rituximab vs Azathioprine for maintenance in EGPA. Remission maintenance rates were similar in both groups with no significant difference in vasculitis, asthma or sinusitis disease flares or corticosteroid burden. Perhaps underpowered to detect small differences but overall a disappointing trial for Rituximab in EGPA.
METOGiA trial outcomes: Compared Tocilizumab vs methotrexate in conjunction with prednisone for GCA. Methotrexate (MTX) was given as 0.3 mg/kg SC weekly injections. Unsurprisingly, MTX patients were more likely to flare and less likely to maintain remission at both 52 and 78 weeks.
And.. a couple of interesting posters:
Differentiating primary ANCA-associated vasculitis (AAV) from secondary (infective endocarditis or drug-induced) ANCA positive vasculitis. The authors identified three key laboratory features that were more suggestive of secondary vasculitis. Always important to consider mimics, we recently saw a patient with endocarditis and a positive PR3 antibody who had all of these laboratory findings.
- Low complement levels
- Leucopaenia
- Thrombocytopaenia
Utilising combined anti-IL-5/IL-5R and dupilupmab (IL-4/IL-13) in EGPA, It is known that while Dupilumab can be highly effective for sinonasal disease and asthma, it can unmask EGPA and hyper eosinophilia so is typically not used in EGPA and there have been concerns about adding it to anti-IL-5 treated EGPA patients with refractory symptoms. This case series from the French Vasculitis Study Group reported a series of 19 refractory sinonasal EGPA patients who were treated with combined therapy (Dupilumab + Benralizumab, 9 pts, Dupilumab + Mepolizumab, 10 pts). 62% patients had complete response, 12.5% had a partial response and 25% had no response. Importantly, no eosionophilia occurred after adding Dupilumab, hence it may be a good add-on therapy (if we can get access!) for patients with refractory disease on anti IL-5 therapies.
