Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear
(2013) In Kidney International 84(2). p.397-402- Abstract
- Patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) requiring dialysis at diagnosis are at risk for developing end-stage renal disease (ESRD) or dying. Shortterm results of a trial comparing plasma exchange (PLEX) to intravenous methylprednisolone (IV MeP) suggested PLEX improved renal recovery. Here we conducted long-term follow-up to see if this trend persisted. A total of 137 patients with newly diagnosed AAV and a serum creatinine over 500 mu mol/l or requiring dialysis were randomized such that 69 received PLEX and 68 received IV MeP in addition to cyclophosphamide and oral glucocorticoids. The patients were followed for a median of 3.95 years. In each group there were 35 deaths, while 23 PLEX and 33 IV MeP... (More)
- Patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) requiring dialysis at diagnosis are at risk for developing end-stage renal disease (ESRD) or dying. Shortterm results of a trial comparing plasma exchange (PLEX) to intravenous methylprednisolone (IV MeP) suggested PLEX improved renal recovery. Here we conducted long-term follow-up to see if this trend persisted. A total of 137 patients with newly diagnosed AAV and a serum creatinine over 500 mu mol/l or requiring dialysis were randomized such that 69 received PLEX and 68 received IV MeP in addition to cyclophosphamide and oral glucocorticoids. The patients were followed for a median of 3.95 years. In each group there were 35 deaths, while 23 PLEX and 33 IV MeP patients developed ESRD. The hazard ratio for PLEX compared to IV MeP for the primary composite outcome of death or ESRD was 0.81 (95% confidence interval 0.53-1.23). The hazard ratio for all-cause death was 1.08 with a subhazard ratio for ESRD of 0.64 (95% confidence interval 0.40-1.05). Thus, although short-term results with PLEX are encouraging, the long-term benefits remain unclear. Further research is required to determine the role of PLEX in AAV. Given the poor outcomes of patients with severe AAV, improved treatment is urgently needed. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4042824
- author
- Walsh, Michael ; Casian, Alina ; Flossmann, Oliver ; Westman, Kerstin LU ; Höglund, Peter LU ; Pusey, Charles and Jayne, David R. W.
- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- plasma exchange, randomized controlled trial, vasculitis
- in
- Kidney International
- volume
- 84
- issue
- 2
- pages
- 397 - 402
- publisher
- Nature Publishing Group
- external identifiers
-
- wos:000322517500025
- scopus:84881171976
- pmid:23615499
- ISSN
- 1523-1755
- DOI
- 10.1038/ki.2013.131
- language
- English
- LU publication?
- yes
- id
- 5cb25a07-0473-4843-b476-f00bcecdb67c (old id 4042824)
- date added to LUP
- 2016-04-01 14:50:27
- date last changed
- 2022-04-14 19:51:21
@article{5cb25a07-0473-4843-b476-f00bcecdb67c,
abstract = {{Patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) requiring dialysis at diagnosis are at risk for developing end-stage renal disease (ESRD) or dying. Shortterm results of a trial comparing plasma exchange (PLEX) to intravenous methylprednisolone (IV MeP) suggested PLEX improved renal recovery. Here we conducted long-term follow-up to see if this trend persisted. A total of 137 patients with newly diagnosed AAV and a serum creatinine over 500 mu mol/l or requiring dialysis were randomized such that 69 received PLEX and 68 received IV MeP in addition to cyclophosphamide and oral glucocorticoids. The patients were followed for a median of 3.95 years. In each group there were 35 deaths, while 23 PLEX and 33 IV MeP patients developed ESRD. The hazard ratio for PLEX compared to IV MeP for the primary composite outcome of death or ESRD was 0.81 (95% confidence interval 0.53-1.23). The hazard ratio for all-cause death was 1.08 with a subhazard ratio for ESRD of 0.64 (95% confidence interval 0.40-1.05). Thus, although short-term results with PLEX are encouraging, the long-term benefits remain unclear. Further research is required to determine the role of PLEX in AAV. Given the poor outcomes of patients with severe AAV, improved treatment is urgently needed.}},
author = {{Walsh, Michael and Casian, Alina and Flossmann, Oliver and Westman, Kerstin and Höglund, Peter and Pusey, Charles and Jayne, David R. W.}},
issn = {{1523-1755}},
keywords = {{plasma exchange; randomized controlled trial; vasculitis}},
language = {{eng}},
number = {{2}},
pages = {{397--402}},
publisher = {{Nature Publishing Group}},
series = {{Kidney International}},
title = {{Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear}},
url = {{http://dx.doi.org/10.1038/ki.2013.131}},
doi = {{10.1038/ki.2013.131}},
volume = {{84}},
year = {{2013}},
}