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Real-life use of the PEXIVAS reduced-dose glucocorticoid regimen in granulomatosis with polyangiitis and microscopic polyangiitis

医学 肉芽肿伴多发性血管炎 美罗华 内科学 显微镜下多血管炎 养生 抗中性粒细胞胞浆抗体 血管炎 环磷酰胺 临床终点 肾脏疾病 胃肠病学 外科 随机对照试验 疾病 化疗 淋巴瘤
作者
Sophie Nagle,Yann Nguyen,Mary‐Jane Guerry,T. Quéméneur,Dimitri Titeca‐Beauport,Thomas Crépin,Rafik Mesbah,Idris Boudhabhay,G. Pugnet,Céline Lebas,A. Néel,Alexandre Karras,É. Hachulla,Juliette Woessner,Vincent Pestre,Raphaël Borie,S. Vinzio,Jean-Baptiste Gouin,Sara Melboucy‐Belkhir,R. Outh
出处
期刊:Annals of the Rheumatic Diseases [BMJ]
卷期号:84 (2): 319-328 被引量:2
标识
DOI:10.1136/ard-2024-226339
摘要

Background

The PEXIVAS (Plasma exchange and glucocorticoids in severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis) trial showed that a reduced-dose glucocorticoid regimen (redGC) was non-inferior to a standard-dose regimen (standGC) with respect to death or end-stage kidney disease (ESKD) in patients with ANCA-associated vasculitis (AAV). However, the primary endpoint did not include disease progression or relapse, cyclophosphamide was the main induction therapy and rituximab (RTX)-treated patients tended to have a higher risk of death or ESKD with redGC. We aimed to evaluate the real-world use of redGC.

Methods

We conducted a retrospective, multicentre study comparing PEXIVAS redGC with standGC in patients with AAV. The primary composite outcome was the occurrence of death, ESKD, AAV progression before remission or relapse within the 12 months following induction. Inverse probability of treatment weighting was used to correct for baseline imbalance between groups. Factors associated with the occurrence of the primary outcome were estimated.

Results

A total of 234 patients were included. The primary composite outcome occurred in 42/126 (33%) patients with redGC versus 20/108 (19%) with standGC. In unweighted multivariable analysis and in weighted analysis, redGC was independently associated with the primary outcome but not with death or ESKD. Among redGC-treated patients, those with serum creatinine>300 µmol/L were more likely to achieve the primary outcome. RTX-treated patients who received redGC were more likely to experience death or ESKD and to achieve the primary outcome.

Conclusion

In this study of patients with AAV primarily treated with RTX, redGC was associated with an increased risk of the primary outcome consisting of death, ESKD, AAV progression before remission or relapse.
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