For many years, despite severe side effects, vasculitides have been managed with high doses of corticosteroids and long-lasting intensive immunosuppression. Recent, innovative approaches have improved our knowledge of the disease pathophysiologies leading to novel treatments that are transforming the standard of care, at least for antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAVs) and again providing new elements to further understanding of the disease mechanisms. Although this could seem to be a virtuous circle of enhanced comprehension and innovation, many questions regarding patient care remain unsolved and a closer look at the past could temper this exciting race to new drug discovery. In this review, we describe the different evidence-based medicine strategies, the drugs that are being tested in AAV patients and novel strategies that should improve AAV treatment. However, the costs and benefits of the development of new treatment strategies are also considered in light of 20 years of clinical trial experience in the field of AAVs.