Advances in Research, Emerging Therapeutic Options in Vasculitis, with Anisha Dua, MD, MPH

There has been a significant surge of interest and research in antineutrophil cytoplasmic antibodies (ANCA) vascularity, making it an exciting time for understanding management options, pathophysiology, biomarkers, and disease approaches. In an interview with HCPLive, Anisha Dua, MD, MPH, highlights the importance of this research, especially given the life-threatening nature of diseases like eosinophilic granulomatosis with polyangiitis (EPGA), granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Her focus is on ANCA vasculitides, shedding light on advancements in therapeutic regimens for EPGA and exploring the roles of plasmapheresis and glucocorticoid strategies in GPA and MPA.

Despite these advancements, the diagnostic landscape remains challenging, lacking a perfect blood test or imaging study. Dua emphasizes ongoing efforts to refine diagnostic abilities with better biomarkers and prognostic clues. The next frontier involves identifying patients' responses to specific treatments based on individual markers or features, aiming to minimize the glucocorticoid burden and address long-term steroid toxicity concerns.

She touches upon ongoing research and diagnostic challenges, addressing questions about when to escalate therapy or adopt more aggressive immunosuppression. Dua emphasizes the need for predicting relapses and intervening early to prevent major damage and discusses ongoing research in the field, especially in eosinophilic diseases, drawing insights from pulmonary and allergy colleagues.

Dua mentions the MIRRA trial, which studied mepolizumab and was approved for use in EPGA. The mechanism of mepolizumab, targeting IL-5 in the th2 or eosinophilic pathway, provides a promising approach. Other drugs like benralizumab and an IL-4 blockade are under development, offering potential options for patients. In GPA and MPA, some studies focus on sparing glucocorticoids.

Dua expresses optimism about the evolving landscape, with new therapeutic targets and options under development. Despite the challenges of managing vasculitis, she encourages clinicians to engage with these complexities, learn from varied experiences, and stay updated on the latest advances.

“What I like about [RWCS] is that there's a lot of back and forth and a lot of different people who have had varying clinical experiences,” Dua concluded. “It's always really nice to have more voices at the table and to hear how people are approaching these diseases differently. Then, we can learn from each other.”

Dua consults for AMGEN, GSK, Sanofi, AstraZeneca, Abbvie, and Sandoz. She receives grant funding from the Rheumatology Research Foundation Clinician Scholar Educator Award, and serves on the board of directors at the Vasculitis Foundation and the Chicago Rheumatism Society.