Recent pathogenetic insights and therapeutic advances in ANCA-associated vasculitis.

Abstract

Advances in the understanding of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis have influenced both treatment strategies and approaches to disease monitoring. While conventional therapies remain the foundation of care, introducing targeted biologics, complement pathway inhibitors, and emerging cellular treatments have broadened therapeutic options to minimise adverse effects, reduce glucocorticoid requirements, and enhance disease control. Nevertheless, many patients still face frequent relapses, progressive tissue damage, and chronic impairments in quality of life. Existing definitions of remission underestimate ongoing disease activity and impact, and interpretation of residual symptoms can be challenging, especially in the absence of overt inflammation. There is a growing interest in personalised management to address these limitations, using biomarkers to better predict relapse risk, differentiate between active disease and residual damage, and guide treatment intensity. Effective long-term care now requires suppression of disease activity and careful management of treatment-related complications, comorbidity risks, and patient-experienced outcomes. Optimising care in ANCA-associated vasculitis will depend on integrating therapeutic innovation with a sustained focus on outcomes that matter most to patients, including durable remission, functional recovery, and improved day-to-day well-being.