There are few data available regarding the optimal duration of immunosuppressive therapy for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). Current treatment includes glucocorticoids; however, the use of those agents is associated with significant morbidity.
Tania Salehi, MBBS, and colleagues conducted a retrospective, observational cohort study examining outcomes among patients who presented with AAV from 2011 to 2013 and who were treated with combination cyclophosphamide and rituximab induction in tandem with a rapidly tapering oral-only glucocorticoid regimen. The researchers analyzed biochemical, histological, and outcome data, including time to remission and rate of relapse.
The cohort included eligible patients; the mean age was 67 years, 85% had kidney involvement, and the mean baseline estimated glomerular filtration rate was 24 mL/min/1.73 m2. Ninety-six percent of the cohort achieved remission, with a median time to remission of 77 days. Improvement in biochemical and histological values was observed following treatment in all patients. Five patients experienced a disease relapse over 2.9 years of follow-up.
The cumulative dose of glucocorticoid was 1,780 mg with a median of 12 weeks duration. The cumulative dose was higher in patients who were treated with oral glucocorticoids for more than 12 weeks (2,935 mg vs 1,133 mg; P<.001), with a trend toward more serious infections compared with patients treated for 12 weeks or less (21% vs 7%; P=0.06). There were no differences in disease remission (100% vs 91%; P=0.07) or relapse (9% vs 0%; P=0.07) between the two groups.
In summary, the authors said, “Early withdrawal of oral glucocorticoid therapy in patients with severe AAV treated with combination cyclophosphamide and rituximab induction immunosuppression is safe and effective and may reduce morbidity, in particular, serious infections.”
Source: Salehi T, et al. Kidney Int Rep. doi:10.1016/j.ekir.2025.04.030
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