Work

Long-Term Follow-Up of a Glucocorticoid Minimizing Regimen for the Treatment of Severe Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis

Year: 2025

Type: article

Abstract: Introduction: Glucocorticoids (GCs) are pivotal in treating antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV); however, their use is associated with significant toxicities. Findings of recent trials support reduced GC dosing, demonstrating efficacy with fewer adverse events. Methods: This was a retrospective cohort study evaluating long-term outcomes of a rapid taper GC regimen in severe AAV. Fifty-eight patients treated with combination rituximab, low-dose i.v. cyclophosphamide, and a limited course of GC (total equivalent prednisolone: 1148 [887-1390] mg; median duration of GC: 14 [7-15] days) were followed-up with for a median of 41 (interquartile range: 27-48) months. Results: , uPCR: 35 [12-94] mg/mmol at 12 months). At 3 years, kidney and overall survival were 33 of 35 (94%) and 35 of 38 (93%), respectively; and 27 of 35 (77%) were in sustained remission without additional GC. Early improvements in disease activity and kidney function-and in long-term kidney and patient survival-were comparable with a previous cohort treated with an equivalent rituximab-cyclophosphamide regimen and a conventional GC taper, whereas adverse events (infection, new-onset diabetes) were less frequent. Conclusion: Ultrarapid GC withdrawal is safe and effective for many patients with AAV when used with combination induction regimens. This approach warrants confirmatory controlled studies and may have a place in the current management of patients at high risk of GC toxicities.

Source: Kidney International Reports

DOI: 10.1016/j.ekir.2025.03.009