Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis

Abstract

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How COVID-19 Has Changed the Management of Glomerular Diseases

“…Postpone all nonessential infusions Adjust schedule so that waiting rooms and infusion suites allow for social distancing with chairs at least 2 m apart Provide face masks for all patients and staff to wear within the facility Frequently clean and decontaminate all equipment and surfaces in patient areas with appropriate contact time for disinfectant Verbally inform patients and post signs about appropriate social distancing and hygiene procedures Recommend remote check-in (e.g., over the phone from outside the facility) to minimize waiting time Screen staff with temperature checks at beginning and end of shift Screen patients by phone prior to their visit about infectious symptoms and exposure to individuals with known COVID-19 infection Cytoplasm Antibody-Associated Vasculitis study showed noninferior outcomes in Anti-Neutrophil Cytoplasm Antibody-associated GN with a reduced dose of corticosteroids compared with a standard dose of corticosteroids (8), the Supportive versus Immunosuppressive Therapy for the Treatment of Progressive IgA Nephropathy and Therapeutic Evaluation of Steroids in IgA Nephropathy Global trials argued against use of high dose corticosteroids for IgA nephropathy (9,10), and the Membranous Nephropathy Trial of Rituximab study found better long-term outcomes with just one or two dosing intervals of rituximab compared with year-long therapy with cyclosporine (11). But we likely will need to go even further than these trials and begin to question, for each glomerular disease, how much immunosuppression is needed to induce a remission and whether long-term maintenance therapy is required to sustain this remission.…”

Update to the ASFA guidelines on the use of therapeutic apheresis in ANCA‐associated vasculitis

“…The PEXIVAS trial, published in February 2020, is the largest randomized controlled trial published to date in ANCA-associated vasculitis (AAV). 1 This study significantly expands the current evidence guiding the use of therapeutic apheresis (TA) in this disorder. This prompted the Writing Committee of the Journal of Clinical Apheresis (JCA) Special Issue to reconvene to perform a review of the existing literature, analyze the quality of evidence, determine the strength of recommendation derived from this evidence, and produce an updated interim fact sheet summarizing evidencebased guidelines on the use of therapeutic apheresis in AAV.…”

Clinical implication of plasma exchange on life-threatening antineutrophil cytoplasmic antibody-associated vasculitis

“…Therefore, PLEX did not have any influence on the rate of all-cause mortality or ESRD occurrence in AAV patients [8]. It could be assumed that the very high mortality rate might interfere and offset the statistical significance of the predictor of all-cause mortality after performing PLEX.…”

“…Whereas, a long-term observational clinical study, PLEX had no significant benefit in AAV patients with serum creatinine > 5.7 mg/dL or on dialysis [7]. Moreover, recently, the data from the Plasma Exchange and Glucocorticoids for Treatment of Anti-Neutrophil Cytoplasm Antibody (ANCA)-Associated Vasculitis (PEXIVAS) clinical trial reported no efficacy of PLEX for reducing the risk of both end-stage renal disease or death in 704 AAV patients [8]. In terms of DAH, several case series reported the positive efficacy of PLEX on DAH yet [9,10].…”