Journal Article

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

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

2019

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / ANCA / Anti-Inflammatory Agents - administration & dosage / Anti-Inflammatory Agents - adverse effects / Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis / Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - epidemiology / Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - immunology / Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - therapy / Antineutrophil cytoplasmic antibodies / Autoantibodies / Care and treatment / Clinical Research / Cohort analysis / Corticosteroid drugs / Corticosteroids / Creatinine / Cyclophosphamide / Diabetes / Diabetes mellitus / Diabetes Mellitus - epidemiology / Diabetes Mellitus - etiology / Dialysis / Drug therapy / Female / Glucocorticoids / Health aspects / Health risk assessment / Humans / Hyperglycemia / Immunosuppressive Agents - therapeutic use / Infection / Infections / Infections - epidemiology / Infections - etiology / Internal Medicine / Intravenous administration / Kidney Function Tests - methods / Lupus / Male / Medical prognosis / Medical research / Medicine / Medicine & Public Health / Methylprednisolone / Methylprednisolone - administration & dosage / Methylprednisolone - adverse effects / Middle Aged / Nephrology / Neutrophils / Outcome and Process Assessment, Health Care / Patient outcomes / Patients / Plasma Exchange - statistics & numerical data / Political aspects / Pulse Therapy, Drug - methods / Recurrence (Disease) / Remission / Remission Induction - methods / Renal Dialysis - statistics & numerical data / Research Article / Retrospective Studies / Risk Assessment / Severity of Illness Index / Steroids (Organic compounds) / Studies / Survival / Transplants & implants / Vasculitis