Clinicians can be “reassured” that the use of lower dose glucocorticoid treatment in patients with severe ANCA-associated vasculitis can be used without sacrificing long-term-disease control, researchers say.
An international collaboration found that neither the use of plasma exchange (PLEX) or standard glucocorticoid regimen appreciably changed the risk of relapse in a post-hoc analysis of 704 patients who participated in the PEXIVAS trial.
The study, which compared plasma exchange or not with standard and reduced glucocorticoid treatment, found relapse was a common event whichever approach was taken.
Overall, 22.7% of patients experienced relapses, the researchers – including Dr Eswari Vilayur from the John Hunter Hospital, New South Wales, reported in Arthritis and Rheumatology.
The analysis showed a relapse rate of 10.3 relapses per 100 patient-years, and neither PLEX (sub-hazard ratio 0.91 to 0.94, 95% CI 0.66 to 1.31) nor glucocorticoid regimen (sub-hazard ratio 0.93 to 0.94, 95% CIs range from 0.67 to 1.35) “appreciably changed” the rate, they concluded.
However, the data pointed out which patients might be more at risk of relapse, particularly around the identification of proteinase 3-ANCA and the presence of non-haemorrhagic respiratory manifestations at trial entry.
By contrast, receiving dialysis at baseline and the use of cyclophosphamide as induction therapy was associated with a lower risk of relapse, they found.
“These findings add confidence to the recommendations to use the reduced-dose glucocorticoid regimen from PEXIVAS,” the researchers concluded.
“Additionally, our study provides further understanding of which patients with ANCA-associated vasculitis are at risk of relapse. These data may help predict disease course and inform decision making regarding the choice and duration of maintenance therapy.”