Low-Dose Intravenous Methylprednisolone in Remission Induction Therapy for ANCA-Associated Vasculitis.

Abstract

Glucocorticoids (GC) remain integral to the management of ANCA associated vasculitis (AAV), but are associated with significant adverse effects. Recent studies have shown reduced oral GC dosing to be safe and effective, however data guiding the use of intravenous (IV) methylprednisolone (MTP) is limited. A single centre, retrospective cohort of patients with AAV were divided into two groups; low-dose GC (patients receiving 250mg IV MTP followed by a tapering course of 30mg prednisolone daily) versus high-dose GC (1.5g IV MTP followed by tapering course of 40-60mg prednisolone daily). Primary outcomes included; end stage kidney disease (ESKD) and mortality, secondary outcomes; glucocorticoid related toxicity, remission and relapse rates. This study was applied to patients with newly diagnosed AAV, including those with severe or life-threatening disease. Sixty-five patients were included in the final analysis, 34 in the high dose and 31 in the low-dose treatment group. At diagnosis, more advanced renal impairment and histological disease was present in the low-dose cohort. The rate of ESKD was similar between groups at 6 and 12 months (P=0.22, P=0.60 respectively). More deaths occurred in the high-dose group (26.5% vs 6.5%, P=0.05) although on multivariable analysis this was not significant (P=0.06). Remission rates were comparable and there was no significant difference in relapses. Adverse events were seen in both groups but the high dose patients experienced a higher number of severe infections, weight gain and steroid induced diabetes. We demonstrate that markedly reduced dose IV MTP with a lower overall cumulative dose GC is safe and effective in the management of severe AAV disease, with no significant difference in primary outcomes.