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

Chanouzas, Dimitrios and McGregor, Julie Anne G and Nightingale, Peter and Salama, Alan D and Szpirt, Wladimir M and Basu, Neil and Morgan, Matthew David and Poulton, Caroline J and Draibe, Juliana Bordignon and Krarup, Elizabeth and Dospinescu, Paula and Dale, Jessica Anne and Pendergraft, William Franklin and Lee, Keegan and Egfjord, Martin and Hogan, Susan L and Harper, Lorraine (2019) Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study. BMC nephrology, 20 (1). p. 58. ISSN 1471-2369. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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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: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WD Diseases and disorders of systemic, metabolic or environmental origin > WD700 Systemic diseases, connective tissue disorders
WG Cardiovascular system. Cardiology
WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Planned IP Care > Vascular
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Depositing User: Beth Connors
Date Deposited: 06 Mar 2019 14:08
Last Modified: 06 Mar 2019 14:08
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1862

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