Reduced Regime of Glucocorticoids and Cyclophosphamide for Mild ANCA-Associated Renal Vasculitis May Delay Deterioration of Renal Function

Abstract

ObjectivesTo compare the efficacy and safety of initial reduced-dose glucocorticoids combined with reduced-frequency cyclophosphamide and to determine risk predictors of end-stage renal disease in ANCA-associated vasculitis（AAV）patients with renal involvement which BVAS was less than 20.MethodsThis is a single-center retrospective cohort study that involved 58 patients who were newly diagnosed with ANCA-associated renal vasculitis. The efficacy and safety of reduced-frequency cyclophosphamide combined with initial reduced-dose glucocorticoids were compared using chi-square test. The cumulative probability to ESRD were estimated using the Kaplan–Meier method and compared using the log rank test. Potential variates were examined using multivariate Cox proportional hazard models to determine the risk predictors of end-stage renal disease.ResultsA total of 35 patients in the standard-dose glucocorticoids group and 23 in the reduced-dose glucocorticoids group were included. The average age of the included patients was 62.45±12.70 years, and the baseline serum creatinine was 251.35[155.53, 445] μmol/L. Nine patients (15.52%) developed ESRD within 24 months (7 Standard vs. 2 Reduced, P=0.035). Multivariate Cox regression model analysis proved that baseline serum creatinine (HR: 0.007, 95%CI: 2.48-39.48, P=0.014), infection rate within first 3 months (HR: 2.28, 95% CI: 2.14 45.27, P=0.003), persistent hematuria for more than 6 months (HR: 1.723, 95%CI: 0.043-0.738, P=0.017) were risk predictors of end-stage renal disease in ANCA-associated renal vasculitis.ConclusionThe regime of initial reduced-dose glucocorticoids combined with reduced-frequency cyclophosphamide is not inferior to the standard regimen in AAV patients with renal involvement which BVAS score was less than 20，and meantime the incidence of infection was significantly lowered. Patients had infection within first 3 months were at higher risk in development of ESRD. To reduce the incidence of infection and thus delay deterioration of renal function, the reduced-dose regime may be more appropriate than standard-dose regimen and can be used as an option in mild patients.