TY - JOUR
T1 - Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis
T2 - a multi-center retrospective cohort study
AU - Chanouzas, Dimitrios
AU - McGregor, Julie Anne G.
AU - Nightingale, Peter
AU - Salama, Alan D.
AU - Szpirt, Wladimir M.
AU - Basu, Neil
AU - Morgan, Matthew David
AU - Poulton, Caroline J.
AU - Draibe, Juliana Bordignon
AU - Krarup, Elizabeth
AU - Dospinescu, Paula
AU - Dale, Jessica Anne
AU - Pendergraft, William Franklin
AU - Lee, Keegan
AU - Egfjord, Martin
AU - Hogan, Susan L.
AU - Harper, Lorraine
PY - 2019/2
Y1 - 2019/2
N2 - Background: Intravenous pulse methylprednisolone (MP) is commonly included in the management of severe ANCA associated vasculitis (AAV) despite limited evidence of benefit. We aimed to evaluate outcomes in patients who had, or had not received MP, along with standard therapy for remission induction in severe AAV. Methods: We retrospectively studied 114 consecutive patients from five centres in Europe and the United States with a new diagnosis of severe AAV (creatinine > 500 μmol/L or dialysis dependency) and that received standard therapy (plasma exchange, cyclophosphamide and high-dose oral corticosteroids) for remission induction with or without pulse MP between 2000 and 2013. We evaluated survival, renal recovery, relapses, and adverse events over the first 12 months. Results: Fifty-two patients received pulse MP in addition to standard therapy compared to 62 patients that did not. There was no difference in survival, renal recovery or relapses. Treatment with MP associated with higher risk of infection during the first 3 months (hazard ratio (HR) 2.7, 95%CI [1.4-5.3], p = 0.004) and higher incidence of diabetes (HR 6.33 [1.94-20.63], p = 0.002), after adjustment for confounding factors. Conclusions: The results of this study suggest that addition of pulse intravenous MP to standard therapy for remission induction in severe AAV may not confer clinical benefit and may be associated with more episodes of infection and higher incidence of diabetes.
AB - Background: Intravenous pulse methylprednisolone (MP) is commonly included in the management of severe ANCA associated vasculitis (AAV) despite limited evidence of benefit. We aimed to evaluate outcomes in patients who had, or had not received MP, along with standard therapy for remission induction in severe AAV. Methods: We retrospectively studied 114 consecutive patients from five centres in Europe and the United States with a new diagnosis of severe AAV (creatinine > 500 μmol/L or dialysis dependency) and that received standard therapy (plasma exchange, cyclophosphamide and high-dose oral corticosteroids) for remission induction with or without pulse MP between 2000 and 2013. We evaluated survival, renal recovery, relapses, and adverse events over the first 12 months. Results: Fifty-two patients received pulse MP in addition to standard therapy compared to 62 patients that did not. There was no difference in survival, renal recovery or relapses. Treatment with MP associated with higher risk of infection during the first 3 months (hazard ratio (HR) 2.7, 95%CI [1.4-5.3], p = 0.004) and higher incidence of diabetes (HR 6.33 [1.94-20.63], p = 0.002), after adjustment for confounding factors. Conclusions: The results of this study suggest that addition of pulse intravenous MP to standard therapy for remission induction in severe AAV may not confer clinical benefit and may be associated with more episodes of infection and higher incidence of diabetes.
KW - ANCA
KW - Diabetes mellitus
KW - Infection
KW - Methylprednisolone
KW - Vasculitis
U2 - 10.1186/s12882-019-1226-0
DO - 10.1186/s12882-019-1226-0
M3 - Journal article
C2 - 30777023
AN - SCOPUS:85061863646
VL - 20
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
M1 - 58
ER -