Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study

Dimitrios Chanouzas, Julie Anne G McGregor, Peter Nightingale, Alan D Salama, Wladimir M Szpirt, Neil Basu, Matthew David Morgan, Caroline J Poulton, Juliana Bordignon Draibe, Elizabeth Krarup, Paula Dospinescu, Jessica Anne Dale, William Franklin Pendergraft, Keegan Lee, Martin Egfjord, Susan L Hogan, Lorraine Harper

    62 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Article number58
    JournalBMC Nephrology
    Volume20
    Issue number1
    Pages (from-to)58
    ISSN1471-2369
    DOIs
    Publication statusPublished - 18 Feb 2019

    Keywords

    • ANCA
    • Diabetes mellitus
    • Infection
    • Methylprednisolone
    • Vasculitis

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