Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Aug;62(8):1166-73.
doi: 10.1002/acr.20176.

Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis

Michael Walsh  1 , Peter A Merkel, Alfred Mahr, David Jayne
Affiliations
Meta-Analysis

Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis

Michael Walsh et al. Arthritis Care Res (Hoboken). 2010 Aug.

Abstract

Objective: Disease relapses are common for patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). The role of low-dose glucocorticoids (GC) in relapse prevention is controversial. We undertook a systematic review and meta-analysis to determine if GC target doses influence relapses of AAV.

Methods: Medline, EMBase, and Cochrane databases were searched for observational studies and randomized controlled trials of treatment of AAV that included a predefined GC treatment plan. The association of GC target dose with the proportion of relapses in studies was assessed using meta-regression and multilevel generalized linear modeling.

Results: Thirteen studies (983 patients) were identified for inclusion. There were no studies directly comparing GC regimens. We classified 288 patients as having a nonzero GC target dose by study end and 695 patients as having a zero GC target dose by study end. The pooled proportion of patients with a relapse was 36% (95% confidence interval [95% CI] 25-47%). GC regimen was the most significant variable explaining the variability between the proportions of patients with relapses. The proportion of patients with a relapse was 14% (95% CI 10-19%) in nonzero GC target dose studies and 43% (95% CI 33-52%) in zero GC target dose studies. Differences other than GC regimens exist between studies that complicate the comparability of trials and isolation of the variability in relapses due to GC target alone.

Conclusion: Studies with longer courses of GC in AAV are associated with fewer relapses. These results have implications for study design and outcome assessment in clinical trials of AAV.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study selection process.
Figure 2
Figure 2
Forest plot of proportion of patients with a relapse in studies of ANCA-associated vasculitis sorted by glucocorticoid (GC) target dose using random effects model. “No GC withdrawal” studies targeted 5 – 7.5 mg prednisone/day; “Late GC withdrawal” studies targeted withdrawal after 12 months; “Early GC withdrawal” studies targeted withdrawal before 12 months. Horizontal lines and diamonds represent 95% confidence intervals of individual studies and pooled group estimates respectively; dotted line represents overall pooled estimate.
See this image and copyright information in PMC

References

    1. Collagen Diseases and Hypersensitivity Panel (MRC) Treatment of polyarteritis nodosa with cortisone: results after three years. Br Med J. 1960;1399:1400. - PMC - PubMed
    1. Frohnert PF, Sheps SG. Long-term folow-up study of periarteritis nodosa. Am J Med. 1967;43:8–11. - PubMed
    1. Fauci AS, Wolff SM, Johnson JS. Effect of cyclophosphamide upon the immune response in Wegener’s granulomatosis. N Engl J Med. 1971;285(27):1493–6. - PubMed
    1. Novack SN, Pearson CM. Cyclophosphamide therapy in Wegener’s granulomatosis. N Engl J Med. 1971;284(17):938–42. - PubMed
    1. Leib ES, Restivo C, Paulus HE. Immunosuppressive and corticosteroid therapy of polyarteritis nodosa. Am J Med. 1979;67:941–5. - PubMed

Publication types

Substances