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A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody-associated vasculitis

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Title: A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody-associated vasculitis
Authors: Pepper, RJ
McAdoo, SP
Moran, SM
Kelly, D
Scott, J
Hamour, S
Burns, A
Griffith, M
Galliford, J
Levy, JB
Cairns, TD
Gopaluni, S
Jones, RB
Jayne, D
Little, MA
Pusey, CD
Salama, AD
Item Type: Journal Article
Abstract: Objectives: Glucocorticoids (GCs) are a mainstay of treatment for patients with ANCA-associated vasculitis (AAV) but are associated with significant adverse effects. Effective remission induction in severe AAV using extremely limited GC exposure has not been attempted. We tested an early rapid GC withdrawal induction regimen for patients with severe AAV. Methods: Patients with active MPO- or PR3-ANCA vasculitis or ANCA-negative pauci-immune glomerulonephritis were included. Induction treatment consisted of two doses of rituximab, 3 months of low-dose CYC and a short course of oral GC (for between 1 and 2 weeks). Clinical, biochemical and immunological outcomes as well as adverse events were recorded. Results: A total of 49 patients were included, with at least 12 months of follow-up in 46. All patients achieved remission, with decreases observed in creatinine, proteinuria, CRP, ANCA level and BVAS. Three patients requiring dialysis at presentation became dialysis independent. Two patients required the introduction of maintenance GC for treatment of vasculitis. Overall outcomes were comparable to those of two matched cohorts (n = 172) from previous European Vasculitis Society (EUVAS) trials, but with lower total exposure to CYC and GCs (P < 0.001) and reduced rates of severe infections (P = 0.02) compared with the RITUXVAS (rituximab versus cyclophosphamide in AAV) trial. We found no new cases of diabetes in the first year compared with historic rates of 8.2% from the EUVAS trials (P = 0.04). Conclusion: Early GC withdrawal in severe AAV is as effective for remission induction as the standard of care and is associated with reduced GC-related adverse events.
Issue Date: 1-Feb-2019
Date of Acceptance: 27-Jul-2018
URI: http://hdl.handle.net/10044/1/64733
DOI: https://doi.org/10.1093/rheumatology/key288
ISSN: 1462-0324
Publisher: Oxford University Press (OUP)
Start Page: 260
End Page: 268
Journal / Book Title: Rheumatology
Volume: 58
Issue: 2
Copyright Statement: © 2018 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in Rheumatology following peer review. The definitive publisher-authenticated version is Ruth J Pepper, Stephen P McAdoo, Sarah M Moran, Dearbhla Kelly, Jennifer Scott, Sally Hamour, Aine Burns, Megan Griffith, Jack Galliford, Jeremy B Levy, Thomas D Cairns, Seerapani Gopaluni, Rachel B Jones, David Jayne, Mark A Little, Charles D Pusey, Alan D Salama; A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody–associated vasculitis, Rheumatology, , key288, https://doi.org/10.1093/rheumatology/key288.
Keywords: Science & Technology
Life Sciences & Biomedicine
Rheumatology
ANCA
vasculitis
glucocorticoids
adverse effects
therapy
DAILY ORAL CYCLOPHOSPHAMIDE
RHEUMATOID-ARTHRITIS
SYSTEMIC VASCULITIS
RANDOMIZED-TRIAL
RITUXIMAB
THERAPY
REMISSION
INDUCTION
GRANULOMATOSIS
EFFICACY
Arthritis & Rheumatology
1103 Clinical Sciences
1107 Immunology
1117 Public Health and Health Services
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-09-18
Appears in Collections:Department of Immunology and Inflammation