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

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. Electronic supplementary material The online version of this article (10.1186/s12882-019-1226-0) contains supplementary material, which is available to authorized users.

Long-term outcomes in elderly patients with ANCA-associated vasculitis

“…Our findings therefore align with those of a recent retrospective analysis of short-term outcomes in severe renal AAV. In this group, IV methylprednisolone use was associated with increased risks of infection and diabetes (and not with any differences in patient or renal survival) [ 29 ].…”

Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis

“…Previous studies in younger patients have shown an association between organ damage and higher cumulative doses and longer duration of glucocorticoid use (10,12). A recently published retrospective study of patients with severe AAV with renal involvement found an association between treatment with intravenous methylprednisolone and higher incidence of diabetes mellitus (20), one of the damage items considered as treatment-related.…”

“…The median initial hospital period was 18 days (IQR[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], and during the first year 69.1%(114/165) of the patients were readmitted to hospital, with a median stay of 12 days (IQR 6-31). Median total hospital stay (including initial stay) during the first year was 31 days (IQR 17-50).…”

The Importance of Demographic and Geographical Factors on the Incidence and Outcome of Systemic Small Vessel Vasculitis Associated with Anti-Neutrophil Cytoplasmic Antibodies

“…Previous studies have found associations between long duration of glucocorticoid use, especially in higher doses, and total organ damage [24,267]. Associations have also been reported between duration of glucocorticoids and cataract [267], and between treatment with intravenous methylprednisolone and development of diabetes mellitus [268,269].…”