A new systematic literature review and meta-analysis has determined that low-dose glucocorticoid (GC) regimens are safe and effective in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
The review, published in the Scandinavian Journal of Rheumatology, found low-dose GC regimens to be noninferior to high-dose regimens in terms of remission and relapse, while also reducing infections.
“High-dose GCs remain a cornerstone of the initial management of AAV; however, this approach carries a significant risk of infection, which is the leading cause of death within 12 months of diagnosis,” the authors wrote. “The aim of the present meta-analysis was to assess the efficacy and safety of low- versus high-dose GC regimens on three outcomes: clinical remission, relapse, and infections.”
The research team assessed the full text of 30 studies published from January 2000 to December 2021 on adults with AAV. Ultimately, two observational studies and 3 randomized, controlled trials covering 1145 patients and comparing oral GC regimens were analyzed.
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The results provided evidence supporting the use of low-dose GC regimens as noninferior to high-dose regimens in terms of remission and relapse as well as reduced infection rates during the first year of GC therapy.
The recognition of the risk of serious and even fatal side effects of high-dose GC regimens has stimulated investigation into low-dose regimens. The results of this review and meta-analysis offer the possibility of reducing dependence on GCs among patients with AAV.
The authors caution that the GC tapering schedules and the timing of outcome assessment varied between studies, particularly in terms of infection. Also, side effects were incompletely reported. However, the comprehensive search strategy and adequate follow-up of the studies on over 1000 patients provide useful evidence supporting the use of low-dose GCs in this patient group.
Reference
Alchi MB, Lever R, Flossmann O, et al. Efficacy and safety of low- versus high-dose glucocorticoid regimens for induction of remission of anti-neutrophil cytoplasm antibody-associated vasculitis: a systematic review and meta-analysis, Scand J Rheumatol. Published online June 20, 2023. doi:10.1080/03009742.2023.2211387
