Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis

• Published in: The New England journal of medicine Vol. 382; no. 7; pp. 622 - 631
• Main Authors: Walsh, Michael, Merkel, Peter A, Peh, Chen-Au, Szpirt, Wladimir M, Puéchal, Xavier, Fujimoto, Shouichi, Hawley, Carmel M, Khalidi, Nader, Floßmann, Oliver, Wald, Ron, Girard, Louis P, Levin, Adeera, Gregorini, Gina, Harper, Lorraine, Clark, William F, Pagnoux, Christian, Specks, Ulrich, Smyth, Lucy, Tesar, Vladimir, Ito-Ihara, Toshiko, de Zoysa, Janak Rashme, Szczeklik, Wojciech, Flores-Suárez, Luis Felipe, Carette, Simon, Guillevin, Loïc, Pusey, Charles D, Casian, Alina L, Brezina, Biljana, Mazzetti, Andrea, McAlear, Carol A, Broadhurst, Elizabeth, Reidlinger, Donna, Mehta, Samir, Ives, Natalie, Jayne, David R.W
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 13.02.2020
• Subjects: Administration, Oral; Adult; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - mortality; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy; Antineutrophil cytoplasmic antibodies; Apheresis; Clinical trials; Combined Modality Therapy; Cyclophosphamide; Cyclophosphamide - therapeutic use; Death; Dose-Response Relationship, Drug; End-stage renal disease; Female; Glomerular filtration rate; Glucocorticoids; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Hemorrhage; Human health and pathology; Humans; Immunosuppressive Agents; Immunosuppressive Agents - therapeutic use; Incidence; Induction Chemotherapy; Kidney Diseases; Kidney Diseases - complications; Kidney Failure, Chronic; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - prevention & control; Life Sciences; Male; Middle Aged; Patients; Plasma; Plasma Exchange; Plasma Exchange - adverse effects; Quality of life; Rituximab; Rituximab - therapeutic use; Statistical analysis; Urology and Nephrology; Vasculitis; Australia

Among patients with severe antineutrophil cytoplasmic antibody–associated vasculitis, plasma exchange did not reduce the incidence of death or end-stage kidney disease. A reduced-dose regimen of oral glucocorticoids was noninferior to a standard-dose regimen with respect to death or ESKD.