Since the publication of the 2021 ACR/Vasculitis Foundation (VF) guidelines, the management options for systemic vasculitides have evolved rapidly. Clinicians are now faced with making new treatment decisions for these rare, complex conditions, including how to integrate post-2021 U.S. Food and Drug Administration (FDA) approvals and emerging trial data into daily practice.
Speakers in Beyond the Guidelines: Updated Management of Systemic Vasculitis aim to bridge the static guideline recommendations with dynamic real-world diagnosis and treatment scenarios across giant cell arteritis (GCA), eosinophilic granulomatosis with polyangiitis (EGPA), and ANCA-associated vasculitides (AAV), such as granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). The session will take place on Tuesday, November 10, from 10–11:30 a.m., in Room W415BC of the Orange County Convention Center. A recording of the session will be available to registered participants of ACR Convergence 2026 for on-demand viewing.
“Guidelines are an essential baseline, but research doesn’t stop once they are published,” said Anisha Dua, MD, MPH, Director of the Vasculitis Center, Northwestern University. “Since 2021, we’ve seen major trial updates, novel FDA approvals, and evolving diagnostic techniques. This session is about translating those recent advances into practical clinical decision-making right now.”
During her talk, Dr. Dua will highlight the changing landscape of interleukin-5 (IL-5)-targeted therapy for EGPA, including the shift away from chronic, low-dose steroid dependence and toward targeted biologic control. She will review key clinical trial updates, including the MANDARA trial that led to the approval of benralizumab and the REOVAS trial, which evaluated rituximab in severe and non-severe EGPA. Dr. Dua will also discuss the expanding use of IL-5 blockade beyond non-severe disease into severe manifestations, such as cardiac involvement, as well as spotlight combination therapies for complex, refractory cases.
“The chronicity of using steroids for a long period of time has been very frustrating for these patients. Many of them were feeling reasonably well but were lingering on 5 mg almost in perpetuity,” said Dr. Dua. “The introduction of newer agents and potential combination therapies has allowed us to move patients away from steroid therapy, which is a huge win.”
Shifting gears, Tanaz Kermani, MD, MS, Director of the Vasculitis Program, UCLA Health, will take a deep dive into the expanding therapeutic toolkit for GCA with a focus on upadacitinib and tocilizumab, the role targeted therapies play in reducing cumulative steroid toxicity, and strategies for managing treatment duration.
Despite all of the significant treatment advances in the past five years, Dr. Kermani said, there are still some unanswered questions. For example, although targeted therapies are beneficial, they do not cure the disease, and relapses occur when therapy is tapered or discontinued.
“Medications like upadacitinib and tocilizumab have changed the landscape of GCA, but an important question not addressed in the guidelines is how long to continue therapy,” she said. “At present, we do not have good predictors of which patients may be able to discontinue therapy and who may need treatment long term. The role of these treatments in preventing vascular complications, like aneurysm formation, also remains unknown.”
Updates in GPA/MPA management will be presented by Sharon Chung, MD, MAS, Director of the Vasculitis Clinic at the University of California, San Francisco. She will address one of the key treatment complexities facing these diseases: the use of the complement inhibitor avacopan and the regulatory challenges it is currently up against. She will also review the experience combining rituximab and cyclophosphamide for remission induction to potentially improve disease outcomes and minimize medication toxicity.
“While dramatic advances have been made in the treatment of GPA and MPA in recent decades, treatment options remain limited for our patients,” said Dr. Chung. “We continue to look for ways to use our available therapies strategically to achieve our treatment goals with the least amount of toxicity.”
THERE’S STILL TIME TO JOIN US
If you haven’t registered for ACR Convergence 2026, you can still register on-site at the Orange County Convention Center in Orlando, Florida, through November 11. All registered participants receive on-demand access to scientific sessions through September 30, 2027.
