Research in Brief

Abstract

Plasma exchange does not reduce the incidence of death or end-stage kidney disease (ESKD) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, while a reduced dose of glucocorticoids is non-inferior to the standard dose, according to a randomised 2 × 2 factorial trial by Michael Walsh and colleagues. 704 patients with ANCA-associated vasculitis enrolled across 16 countries were randomly assigned (1:1) to undergo plasma exchange (seven exchanges within 14 days) or no plasma exchange; patients were also randomly assigned to receive a standard or reduced dose of oral glucocorticoids. Death from any cause or ESKD (the composite primary outcome) occurred in 100 (28%) of 352 patients in the plasma exchange group versus 109 (31%) of 352 patients in the control group (hazard ratio [HR] 0·86, 95% CI 0·65–1·13; p=0·27). Death or ESKD occurred in 92 (28%) of 330 patients receiving a reduced dose and in 83 (26%) of 325 patients receiving a standard dose of glucocorticoids (absolute risk difference 2·3 percentage points, 90% CI −3·4 to 8·0; predefined non-inferiority margin 11 percentage points). Serious adverse events were similar between groups; however, serious kidney-related adverse events were more common (unadjusted risk ratio 1·84; 95% CI 1·18–2·87) and serious infections at 1 year less common (incidence rate ratio 0·69; 95% CI 0·52–0·93) in patients receiving a reduced dose than in those receiving the standard dose of glucocorticoids.