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What is ANCA-Associated Vasculitis (AAV)?

Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis describes a group of rare diseases that cause inflammation in small- to medium-sized blood vessels in your body. This inflammation can reduce blood flow, impacting the organs and how they work. The exact cause of ANCA-associated vasculitis is currently unknown, but it is thought to be a combination of genetic and environmental factors.

The 2 most common subtypes of ANCA-associated vasculitis are:

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Granulomatosis with polyangiitis (GPA)

GPA is a disease resulting from inflammation of the blood vessels. In GPA, immune cells can cluster to form what is called a granuloma. The lungs, kidney, sinuses, ears, nose, and throat are often affected.

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Microscopic polyangiitis (MPA)

MPA shares similarities with GPA, but granulomas don't form. The impact on the kidneys may be more severe, and people with MPA may be more likely to have bleeding in their lungs.

Some terms you may hear when describing these diseases are: severe and active.

Severe

“Severe disease” means that you have signs and/or symptoms of ANCA-associated vasculitis that could be organ- or life-threatening.

Active

“Active disease” means that you have signs and/or symptoms of the disease that are new, not getting better, or getting worse.

About 80-90% of patients with ANCA-associated vasculitis have kidney- or other organ-threatening signs and symptoms, which can be considered severe active disease

How does AAV affect the body?

GPA and MPA can impact many different parts of your body. This diagram can help you understand some of the signs and symptoms of GPA and MPA. For ~50% of people,* even in remission, vasculitis symptoms are debilitating, so it is important to keep track of signs and symptoms and discuss them with your doctor. Keeping a notebook or journal can help you have an organized conversation with your doctors to take control of your treatment.

Additionally, signs and/or symptoms can be persistent. While relapse is common with GPA and MPA, it is often associated with significant harm.

What signs of AAV (GPA/MPA) should I look out for?
Eye
Eyes

Irritated eyes, blurred vision

If you notice any of these symptoms, it is important to tell your doctor and discuss which treatments are available to help you manage them. Please note these are just some of the signs and symptoms of GPA or MPA. Severe active GPA or MPA can present differently in each patient.

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According to an online, self-administered survey of 100 patients with GPA or MPA from July 21-August 25, 2022.

Remission is the lack of GPA or MPA symptoms on or off immunosuppressive therapy.

What should I look out for when managing severe active GPA or MPA?

When managing severe active GPA or MPA, you and your doctor may face challenges with the disease as well as the medications you may be taking to treat it.

It can often feel difficult or overwhelming managing severe active GPA or MPA. It is possible to address these challenges with your doctor to help manage your GPA or MPA.

Click on each of the challenges below to learn more about managing severe active GPA or MPA, and the importance of talking about these with your doctor.

Click on each of the challenges below to learn more about managing severe active GPA or MPA, and the importance of talking about these with your doctor.

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Timely Diagnosis
Achieving Remission
Achieving Remission
Preventing relapse
Preventing Relapse
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Treatment Toxicity
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Impact on Organ Function
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Effect on Quality of Life

How are GPA and MPA diagnosed?

Since GPA and MPA share many signs and symptoms with other diseases, diagnosing them can be tricky. However, early diagnosis is extremely important to coming up with a treatment plan that can help manage these conditions.

There are a number of ways your doctor will try to confirm a potential GPA or MPA diagnosis:

Physical examination
Physical examination to evaluate organ involvement and rule out other illnesses that may look similar
Test tube
Blood tests for anti-neutrophil cytoplasmic antibodies (ANCA), which can support a suspected diagnosis. However, the diagnosis of GPA and MPA can’t be shown by a blood test alone
Urine tests
Urine tests to determine if your kidneys have been impacted
Imaging tests
Other tests such as X-rays, computed tomography (CT) scans, biopsies, or magnetic resonance (MR) scans, which can help identify abnormalities in affected areas such as the lungs

Depending on how GPA or MPA has impacted your body, you may need to see different types of doctors, such as a rheumatologist or nephrologist, to help manage your symptoms.

Once a diagnosis of GPA or MPA is suspected, a tissue sample of the affected area known as a biopsy may be performed to confirm the presence of vasculitis. Treatment should not necessarily be delayed for a biopsy. However, biopsies can be helpful when trying to understand if an organ is impacted by GPA or MPA.

How are severe active GPA and MPA treated?

The right treatment may make a difference in GPA or MPA

To help control disease activity, your doctor may prescribe immunosuppressants, such as glucocorticoids.

Immunosuppressants

Immunosuppressants are medications that target inflammation by lowering the activity of the body’s immune system and can be used to to help you reach remission.

Glucocorticoids

Glucocorticoids (also called steroids), such as prednisone, are one type of immunosuppressant. While glucocorticoids can be helpful in controlling disease activity, they can also cause serious side effects. This is especially true if used over a long period. To help, doctors are shifting to treatments that can reduce the time a person takes high-dose glucocorticoids.

There are several treatment options available for patients with GPA and MPA. It is important to talk to your doctor about what treatment options may be right for you.

How can I best advocate for myself during my severe active GPA or MPA journey?

“For someone who is newly diagnosed…ask a lot of questions. Fight for yourself because you’ve got to take care of your whole being. Living a healthy life as a rare disease patient encompasses all facets of life.”

– Brandon, person living with GPA

Have an open conversation

Open conversation between you and your doctor is very important because you both may have different expectations of what successful treatment looks like. Be sure to have open communication on any questions or concerns you may have and let them know of any changes in your health that you may be experiencing.

Below are some questions that can help you and your doctor talk about important topics when it comes to your treatment and expectations.

  • What does successful severe active GPA or MPA management look like for me?
  • What role do I and do you, doctor, play during my GPA or MPA journey?
  • When could I start to feel a difference from my severe active GPA or MPA treatment regimen?
  • When are my symptoms considered to be in remission?
  • What happens if my symptoms return after being in remission?
  • When should I tell you if I start having symptoms again?
  • Which medications are approved for severe active ANCA-associated vasculitis (AAV), specifically GPA and MPA?

Prepare for your appointment

It is important to be organized and use your time wisely with your doctor. Some tips to consider:

  • Ask about your current treatment regimen, and if there are any other options for you to try
  • Share your GPA or MPA symptoms and medication side effects, both physical and the impact to your quality of life
  • Don’t be afraid to ask for clarification if anything is unclear or you have doubts about their recommendations
  • Make sure you understand next steps and any follow-up instructions to help successfully manage your severe active GPA or MPA
  • Make note of any symptoms you may be experiencing in between visits and let your doctor know about them, especially if they are persisting or impacting your quality of life
  • Send your doctor any questions or comments you may have before your visit in your doctor-patient portal

“For someone who is newly diagnosed…ask a lot of questions. Fight for yourself because you’ve got to take care of your whole being. Living a healthy life as a rare disease patient encompasses all facets of life.”

– Brandon, person living with GPA

Hear what other patients have to say about their own journey with GPA or MPA

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Are there any useful tips that can help me on my journey?

  • Find out all you can about your condition
    Get as much information as possible about severe active GPA or MPA as well as the medications you’re taking. It’s important to know the possible side effects of your medications and let your doctor know of any changes in your health that might occur.

  • Follow your treatment plan
    Your doctor will work with you to develop a treatment plan that suits your needs. Make sure you stick to this treatment plan and clearly communicate with your doctor on a regular basis.

  • Eat healthy
    A healthy diet of fresh fruits and vegetables, whole grains, low-fat dairy products, and lean meats and fish can help with overall health.

  • Incorporate movement into your day
    Incorporating more movement into your daily routine can be beneficial for overall health. Be sure to start slow, and always consult your healthcare provider before starting any new exercise.

You’re not alone

Connecting with people like you can also provide a sense of community and support. The following organizations provide education, support, and resources that may help you throughout your journey.

These organizations are not owned or controlled by Amgen, and Amgen is not responsible for their content. However, you may find them helpful.

Vasculitis Foundation logo
The Vasculitis Foundation

The Vasculitis Foundation supports, inspires, and empowers people and families living with vasculitis through a wide range of education, research, clinical, and awareness initiatives.

Eosinophilic-logo
Eosinophilic & Rare Disease Cooperative

The ERDC (Eosinophilic & Rare Disease Cooperative) is dedicated to helping improve access to care, treatment and improved outcomes for people with rare disease.

American Kidney Fund® logo
American Kidney Fund

The American Kidney Fund (AKF) works on behalf of Americans living with and at risk of kidney disease with programs that support people from prevention through transplant and beyond.

NORD® logo
NORD (National Organization for Rare Disorders)

NORD (National Organization for Rare Disorders) is a patient advocacy organization committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and patient services.

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Timely Diagnosis

Recognizing the signs and symptoms of severe active GPA or MPA at an early stage can lead to a timely diagnosis. An early diagnosis allows you and your doctor to work together to decide on a plan to help manage your condition.

However, about 1/3 of people experience a significant diagnostic delay of more than 6 months.

Achieving Remission
Achieving Remission

The goal of treatment is to achieve and sustain remission. Remission is the lack of GPA or MPA signs or symptoms on or off immunosuppressive therapy. Response to initial treatment for severe active GPA or MPA varies and some people do not achieve remission.

It is critical to keep track of your symptoms and tell your doctor when you feel like they may be coming back. This can help you and your doctor decide on the best way to manage your GPA or MPA to prevent relapse.

Preventing relapse
Preventing Relapse

GPA and MPA are chronic diseases that can relapse. This means that while there may be times where it seems like your symptoms are getting worse, there may also be times where symptoms seem to get better as well.

Relapse is when your GPA or MPA symptoms return after being previously controlled. Preventing relapse is key to staying in remission.

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Treatment Toxicity

Steroids, called glucocorticoids, are commonly used for GPA and MPA treatment, but they can have side effects.

Up and down arrows on human body outline
Impact on Organ Function

AAV could lead to impacted organ function, especially in the lungs and kidneys.

AAV threatens the kidneys or another organ in about 80% - 90% of cases, which can be considered severe active disease.

The Rarity and Nonspecific Presentation of GPA and MPA Can Lead to Delays in Diagnosis1

About one-third of patients experience a significant diagnostic delay of more than 6 months1

Though many patients show renal disease, presenting manifestations can stretch across multiple organ systems2

Rarity and Nonspecific Presentation of Severe Active
GPA and MPA

Presence of common comorbidities (>6%) may further complicate diagnosis3

Rarity and Nonspecific Presentation of Severe Active
GPA and MPA

As a result, 16% of patients have had their referral symptoms for approximately 3 months before receiving their diagnosis3

ENT = ear, nose, throat.; COPD = chronic obstructive pulmonary disease.

COPD = chronic obstructive pulmonary disease; ENT = ear, nose, throat.

Diagnosis requires a careful, systematic approach that can identify multi-organ system involvement.1
References: 1. Yates M, Watts R. Clin Med (Lond). 2017;17(1):60-64. 2. Hunter RW, Welsh N, Farrah TE, et al. BMJ. 2020;369:m1070. 3. Rutherford P, Goette D. Poster presented at: World Congress of Nephrology 2020; March 26-29, 2020; Abu Dhabi, United Arab Emirates. Abstract SUN-375.