How do you determine which patients with ANCA associated vasculitis may be good candidates for reduced dose glucocorticoid tapering?

This is an important question. Currently there are several groups of patients that benefit from reduced dose glucocorticoids:

• The largest group are patients who are receiving avacopan for remission induction. The ADVOCATE trial demonstrated that avacopan can markedly reduce the dose of glucocorticoids received during remission induction with similar or improved outcomes (e.g. may have particular benefit in patients with renal disease). I am currently using avacopan for all patients with severe disease if patients have access and tolerate it. However, the optimal dose and duration of GCs with avacopan remains uncertain and subgroups that may not need any GCs beyond the first week have not been defined.
• For patients who are not receiving avac...