Risks and Benefits of Glucocorticoids in ANCA-Associated Vasculitis

Abstract

Purpose of Review Glucocorticoids are a cornerstone in the treatment of ANCA-associated vasculitis. However, the role of long-term, low-dose glucocorticoids for the prevention of relapses is uncertain and substantial practice pattern variation exists. In this review, we will explore evidence supporting or refuting the position that low-dose glucocorticoids modify the risk of relapse in ANCA-associated vasculitis. Recent findings Basic experimental studies suggest glucocorticoids could modify the course of ANCA-associated vasculitis and clinical studies suggest patients treated with longer courses of glucocorticoids are free of relapse for longer periods than patients treated with shorter courses. Some studies, however, are conflicting. Summary There continues to be a dearth of high quality evidence addressing the use of low-dose glucocorticoids in ANCA-associated vasculitis. Although ongoing trials will help inform this fundamental treatment question, large, high-quality trials are needed.