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CanVasc consensus recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis: 2020 update

Author

J Rheumatol. 2020 Sep 15;jrheum.200721. doi: 10.3899/jrheum.200721. Online ahead of print.

Arielle Mendel 1, Daniel Ennis 1, Ellen Go 1, Volodko Bakowsky 1, Corisande Baldwin 1, Susanne M Benseler 1, David A Cabral 1, Simon Carette 1, Marie Clements-Baker 1, Alison Clifford 1, Jan Willem Cohen Tervaert 1, Gerard Cox 1, Natasha Dehghan 1, Christine Dipchand 1, Navjot Dhindsa 1, Leilani Famorca 1, Aurore Fifi-Mah 1, Stephanie Garner 1, Louis-Philippe Girard 1, Clode Lessard 1, Patrick Liang 1, Damien Noone 1, Jean-Paul Makhzoum 1, Nataliya Milman 1, Christian A Pineau 1, Heather N Reich 1, Maxime Rhéaume 1, David B Robinson 1, Dax G Rumsey 1, Tanveer E Towheed 1, Judith Trudeau 1, Marinka Twilt 1, Elaine Yacyshyn 1, Rae Yeung 1, Lillian Barra 1, Nader Khalidi 1, Christian Pagnoux 1

Author Information

1 Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario.; Division of Rheumatology, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Rheumatology, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia; Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Alberta; Children's Hospital Research Institute, University of Calgary; Division of Pediatric Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia; Division of Rheumatology, Queen's University, Kingston, Ontario; Division of Rheumatology, University of Alberta, Edmonton, Alberta; Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario; Division of Nephrology, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia; Division of Rheumatology, McMaster University, Hamilton, Ontario; Division of Rheumatology, University of Calgary, Calgary, Alberta; Division of Nephrology, University of Calgary, Calgary, Alberta; Centre de Recherche Musculo-Squelettique, Trois-Rivières, Québec; Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec; Division of Nephrology, Hospital for Sick Children, University of Toronto, Toronto, Ontario; Division of Internal Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec; Division of Rheumatology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario; Division of Rheumatology, Lupus and Vasculitis Clinic, McGill University, Montréal, Québec; Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario; Section of Rheumatology, University of Manitoba, Winnipeg, Manitoba; Division of Pediatric Rheumatology, University of Alberta, Edmonton, Alberta; Division of Rheumatology, CISSS Chaudière-Appalaches, Université Laval, Quebec City, Québec; Division of Rheumatology, Department of Medicine, Western University, London, Ontario. Address correspondence to Dr Arielle Mendel, MD, FRCPC, MSc, Mount Sinai Hospital, 60 Murray Street Room 2-226, Toronto, Ontario. E-Mail: arielle.mendel@mail.mcgill.ca.

Abstract

Objective: In 2015, the Canadian Vasculitis Research Network (CanVasc) created recommendations for the management of antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV) in Canada. The current update aimed to revise existing recommendations and create additional recommendations, as needed, based on a review of new available evidence.

Methods: A needs assessment survey of CanVasc members informed questions for an updated systematic literature review (publications spanning May 2014-September 2019) using Medline, Embase, and Cochrane. New and revised recommendations were developed and categorized according to the level of evidence and strength of each recommendation. The CanVasc working group used a two-step modified Delphi procedure to reach >80% consensus on the inclusion, wording and grading of each new and revised recommendation.

Results: Eleven new and 16 revised recommendations were created, and 12 original (2015) recommendations were retained. New and revised recommendations are discussed in detail within this document. Five original recommendations were removed, of which 4 were incorporated into the explanatory text. The supplementary appendix for practical use was revised to reflect the updated recommendations.

Conclusion: The 2020 updated recommendations provide rheumatologists, nephrologists, and other specialists caring for patients with AAV in Canada with new management guidance, based on current evidence and consensus from Canadian experts.