ANCA and Large Vessel Vasculitis developments in 2026

09/04/2026

A brief respite over the Easter break means I had some time to reflect on recent developments and future directions in the vasculitis space. Read on below!

Biennial international vasculitis workshop

  • Took place in Melbourne on late February, organised by ANZVASC. It exceeded all of our expectations in terms of attendees (> 1000 delegates), quality of presentations and research output. It was great to welcome patients on the Saturday 21st February at the full day patient and community conference!

ANCA associated vasculitis:

  • FDA warning on Avacopan. Association between Avacopan use and liver injury with vanishing bile duct syndrome. There may be a causal relationship. This was seen predominantly in Japanese patients. We need to watch this space and check liver function tests more regularly for patients on Avacopan.
  • Escalation of anti-IL-5 therapy in refractory EGPA from eosinophilic asthma dosing (mepolizumab 100mg four-weekly) to EGPA dosing (mepolizumab 300mg four-weekly). A poster at the 2026 vasculitis workshop from the European EGPA study group reported a 41% complete response in 141 patients after escalation.
  • Increasing interest in deeper B cell depletion with Obinutuzumab in refractory ANCA associated vasculitis. This medication has proven to be a effective in SLE, confirming that deeper B cell depletion has a role in refractory systemic autoimmune disease. We also look forward to the results of the phase 2 ObiVas trial.

Large vessel vasculitis

  • Roche has withdrawn its co-pay program for new patients with GCA requiring Tocilizumab therapy beyond the 12 months of PBS supply. This will necessitate re-assessment of treatment protocols. The option for a re-induction course of Tocilizumab on PBS or longer term therapy for a subgroup of patients would provide a solution here and will require ARA and patient advocacy. Watch this space.
  • Takayasu arteritis. Preliminary results from a Chinese trial of 104 patients presented at the vasculitis workshop indicate that Adalimumab may be more effective in preventing disease relapse than Secukinumab. This will not change current treatment pathways preferring anti-TNF or IL-6 therapy.
  • Upadacitinib is not yet TGA or PBS approved for treatment of GCA in Australia. We look forward to developments in this space with the SELECT-GCA trial having demonstrated efficacy similar to Tocilizumab with a satisfactory safety profile to 24 months.