Long-Term Follow-Up of a Glucocorticoid Minimizing Regimen for the Treatment of Severe Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis
Introduction: Glucocorticoids (GCs) are pivotal in treating antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV); however, their use is associated with significant toxicities. Findings of recent trials support reduced GC dosing, demonstrating efficacy with fewer adverse events....
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| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024925001378 |
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| Summary: | Introduction: Glucocorticoids (GCs) are pivotal in treating antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV); however, their use is associated with significant toxicities. Findings of recent trials support reduced GC dosing, demonstrating efficacy with fewer adverse events. Methods: This was a retrospective cohort study evaluating long-term outcomes of a rapid taper GC regimen in severe AAV. Fifty-eight patients treated with combination rituximab, low-dose i.v. cyclophosphamide, and a limited course of GC (total equivalent prednisolone: 1148 [887–1390] mg; median duration of GC: 14 [7–15] days) were followed-up with for a median of 41 (interquartile range: 27–48) months. Results: Median Birmingham Vasculitis Activity Score (BVAS), serum creatinine, estimated glomerular filtration rates (eGFR), and urinary protein-to-creatinine ratio (uPCR) at presentation were 14 (12–18), 176 (132–270) μmol/l, 29 (19–50) ml/min per 1.73 m2, and 152 (77–289) mg/mmol, respectively. At 3 months, 51 of 58 (88%) achieved remission without additional GC treatment, and this was sustained in 49 of 56 (88%) at 1 year, with improved kidney parameters (creatinine: 109 [83–162] μmol/l, eGFR: 54 [37–74]ml/min per 1.73 m2, uPCR: 35 [12–94] mg/mmol at 12 months). At 3 years, kidney and overall survival were 33 of 35 (94%) and 35 of 38 (93%), respectively; and 27 of 35 (77%) were in sustained remission without additional GC. Early improvements in disease activity and kidney function—and in long-term kidney and patient survival—were comparable with a previous cohort treated with an equivalent rituximab-cyclophosphamide regimen and a conventional GC taper, whereas adverse events (infection, new-onset diabetes) were less frequent. Conclusion: Ultrarapid GC withdrawal is safe and effective for many patients with AAV when used with combination induction regimens. This approach warrants confirmatory controlled studies and may have a place in the current management of patients at high risk of GC toxicities. |
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| ISSN: | 2468-0249 |