Low-dose intravenous methylprednisolone may be safe and effective for the management of severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), according to an article published in Kidney360.
This single-center, retrospective study included a cohort of 65 patients who were newly diagnosed with AAV, including those with severe or life-threatening forms of the disease. They were divided into 2 groups.
The high-dose glucocorticoid group included 34 patients receiving 1.5 g of intravenous methylprednisolone followed by a 40 to 60 mg prednisolone daily tapering course. The low-dose glucocorticoid group included 31 patients receiving 250 mg of intravenous methylprednisolone followed by a 30 mg prednisolone daily tapering course.
The researchers evaluated end-stage kidney disease and mortality as the primary outcome measures. Secondary outcome measures included glucocorticoid-related toxicity, remission, and relapse rates.
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According to the study results, patients belonging to the low-dose cohort had more advanced renal impairment and histological evidence of disease at diagnosis compared with the high-dose group patients. At 6 and 12 months, the rate of end-stage kidney disease was comparable between groups.
The researchers reported more death outcomes in the high-dose group compared with the low-dose group (26.5% vs 6.5%, P =.05), although the difference was deemed insignificant by multivariable analysis (P =.06). There were no significant differences in the remission rates and relapses between the groups.
Moreover, all patients experienced adverse events. Those in the high-dose group reported a higher number of severe infections, weight gain, and steroid-induced diabetes.
“It is increasingly recognized that the use of lower dose, oral glucocorticoids is feasible in the management of AAV and that further research assessing the role of intravenous methylprednisolone is needed. The use of intravenous methylprednisolone as part of remission induction therapy is widely adopted, however, its toxic effects and contribution to the cumulative burden of glucocorticoid exposure may often be overlooked with a limited evidence base supporting its use,” Floyd and colleagues noted.
Recent studies have shown reduced oral glucocorticoid dosing to be safe and effective, however, data guiding the use of intravenous methylprednisolone remains limited.
Floyd L, Morris A, Shetty A, et al. Low dose intravenous methylprednisolone in remission induction therapy for ANCA-associated vasculitis. Kidney360. Published online September 5, 2023. doi:10.34067/KID.0000000000000222