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

Chanouzas, D. et al. (2019) Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study. BMC Nephrology, 20, 58. (doi: 10.1186/s12882-019-1226-0) (PMID:30777023) (PMCID:PMC6378728)

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.

• Item Type: Articles
• Additional Information: DC was funded by a Wellcome Trust research training fellowship (097962/Z/11/Z). This work was also supported in part by the NIH/NIDDK (P01DK058335) grant (Chapel Hill, USA).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Basu, Professor Neil
• Authors: Chanouzas, D., McGregor, J. A. G., Nightingale, P., Salama, A. D., Szpirt, W. M., Basu, N., Morgan, M. D., Poulton, C. J., Draibe, J. B., Krarup, E., Dospinescu, P., Dale, J. A., Pendergraft, W. F., Lee, K., Egfjord, M., Hogan, S. L., and Harper, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: BMC Nephrology
• Publisher: BMC
• ISSN: 1471-2369
• ISSN (Online): 1471-2369
• Copyright Holders: Copyright © The Author(s). 2019
• First Published: First published in BMC Nephrology 20:58
• Publisher Policy: Reproduced under a Creative Commons license