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
Multicenter Study
. 2019 Feb 18;20(1):58.
doi: 10.1186/s12882-019-1226-0.

Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study

Dimitrios Chanouzas  1   2 , Julie Anne G McGregor  3 , Peter Nightingale  2 , Alan D Salama  4 , Wladimir M Szpirt  5 , Neil Basu  6 , Matthew David Morgan  1   2 , Caroline J Poulton  3 , Juliana Bordignon Draibe  4 , Elizabeth Krarup  5 , Paula Dospinescu  6 , Jessica Anne Dale  2 , William Franklin Pendergraft  3 , Keegan Lee  4 , Martin Egfjord  5 , Susan L Hogan  3 , Lorraine Harper  7   8
Affiliations
Multicenter Study

Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study

Dimitrios Chanouzas et al. BMC Nephrol. .

Abstract

Background: Intravenous pulse methylprednisolone (MP) is commonly included in the management of severe ANCA associated vasculitis (AAV) despite limited evidence of benefit. We aimed to evaluate outcomes in patients who had, or had not received MP, along with standard therapy for remission induction in severe AAV.

Methods: We retrospectively studied 114 consecutive patients from five centres in Europe and the United States with a new diagnosis of severe AAV (creatinine > 500 μmol/L or dialysis dependency) and that received standard therapy (plasma exchange, cyclophosphamide and high-dose oral corticosteroids) for remission induction with or without pulse MP between 2000 and 2013. We evaluated survival, renal recovery, relapses, and adverse events over the first 12 months.

Results: Fifty-two patients received pulse MP in addition to standard therapy compared to 62 patients that did not. There was no difference in survival, renal recovery or relapses. Treatment with MP associated with higher risk of infection during the first 3 months (hazard ratio (HR) 2.7, 95%CI [1.4-5.3], p = 0.004) and higher incidence of diabetes (HR 6.33 [1.94-20.63], p = 0.002), after adjustment for confounding factors.

Conclusions: The results of this study suggest that addition of pulse intravenous MP to standard therapy for remission induction in severe AAV may not confer clinical benefit and may be associated with more episodes of infection and higher incidence of diabetes.

Keywords: ANCA; Diabetes mellitus; Infection; Methylprednisolone; Vasculitis.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and cosent to participate

This was a quality improvement project where data was collected as part of routine clinical care. Furthermore patients were diagnosed and treated according to currently accepted recommendations. The purpose of this analysis was improvement of clinical care rather than primary research. The authors had access to the data as part of their role as care providers to the patients involved however all data was anonymised at the data collection stage. For these reasons ethical approval and / or patient consent was not sought. This was discussed and agreed with the R&D Department at University Hospital Birmingham.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Time to survival by 12 months was examined by Kaplan-Meier curve analysis. Survival for patients that received MP is shown in the dashed line and that for non-MP treated patients in the solid line
Fig. 2
Fig. 2
Time to leukopenia by 12 months was examined by Kaplan-Meier curve analysis. Time to leukopenia for patients that received MP is shown in the dashed line and that for non-MP treated patients in the solid line
Fig. 3
Fig. 3
Time to infection overall (left panel) and severe infection (right panel) by 12 months was examined by Kaplan-Meier curve analysis. Time to infection is shown in the dashed line for patients that received MP and in the solid line for non-MP treated patients. The difference in infection is confined to the first 3 months as can be seen by the curves being essentially parallel from 3 months onwards
Fig. 4
Fig. 4
Time to new onset diabetes by 12 months was examined by Kaplan-Meier curve analysis and is shown in the dashed line for patients that received MP and in the solid line for patients that were not treated with MP
See this image and copyright information in PMC

References

    1. Jennette JC, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994;37(2):187–192. doi: 10.1002/art.1780370206. - DOI - PubMed
    1. Hamour S, Salama AD, Pusey CD. Management of ANCA-associated vasculitis: current trends and future prospects. Ther Clin Risk Manag. 2010;6:253–264. - PMC - PubMed
    1. Jayne DR, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol. 2007;18(7):2180–2188. doi: 10.1681/ASN.2007010090. - DOI - PubMed
    1. Walsh M, et al. Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear. Kidney Int. 2013;84(2):397–402. doi: 10.1038/ki.2013.131. - DOI - PubMed
    1. McGregor JG, et al. Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin J Am Soc Nephrol. 2012;7(2):240–247. doi: 10.2215/CJN.05610611. - DOI - PMC - PubMed

Publication types

MeSH terms