Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study
Intravenous pulse methylprednisolone for induction of remission in severe ANCA associated Vasculitis: a multi-center retrospective cohort study
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DOI：
10.1186/s12882-019-1226-0
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发表时间：
2019-02-18
期刊：
影响因子：
2.3
通讯作者：
Harper, Lorraine
中科院分区：
文献类型：
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作者：
Chanouzas, Dimitrios;McGregor, Julie Anne G.;Harper, Lorraine
背景静脉冲击甲基强的松龙（MP）通常用于治疗严重ANCA相关性血管炎（AAV），尽管获益证据有限。我们的目的是评估患者的结局，这些患者接受或未接受MP，沿着标准治疗以诱导重度AAV缓解。方法我们回顾性研究了来自欧洲和美国5个中心的114例新诊断为重度AAV的连续患者。（肌酐>500 mol/L或透析依赖性）和接受标准治疗（血浆置换、环磷酰胺和高剂量口服皮质类固醇），用于缓解诱导，伴或不伴脉冲MP。我们评估了生存率，肾功能恢复，复发，和不良事件在第一个12months.Results52例患者接受脉冲MP除了标准治疗相比，62例患者没有。在生存率、肾功能恢复或复发率方面没有差异。MP治疗与前3个月内感染风险较高相关（风险比（HR）2.7，95%CI [1.4-5.3]，p=0.004）和糖尿病发病率较高（HR 6.33 [1.94-20.63]，p=0.002），结论：本研究结果提示，在诱导缓解的标准治疗基础上，在严重的AAV中，可能不赋予临床益处，并且可能与更多的感染发作和更高的糖尿病发病率相关。
BackgroundIntravenous pulse methylprednisolone (MP) is commonly included in the management of severe ANCA associated vasculitis (AAV) despite limited evidence of benefit. We aimed to evaluate outcomes in patients who had, or had not received MP, along with standard therapy for remission induction in severe AAV.MethodsWe retrospectively studied 114 consecutive patients from five centres in Europe and the United States with a new diagnosis of severe AAV (creatinine >500 mol/L or dialysis dependency) and that received standard therapy (plasma exchange, cyclophosphamide and high-dose oral corticosteroids) for remission induction with or without pulse MP between 2000 and 2013. We evaluated survival, renal recovery, relapses, and adverse events over the first 12months.ResultsFifty-two patients received pulse MP in addition to standard therapy compared to 62 patients that did not. There was no difference in survival, renal recovery or relapses. Treatment with MP associated with higher risk of infection during the first 3 months (hazard ratio (HR) 2.7, 95%CI [1.4-5.3], p=0.004) and higher incidence of diabetes (HR 6.33 [1.94-20.63], p=0.002), after adjustment for confounding factors.ConclusionsThe results of this study suggest that addition of pulse intravenous MP to standard therapy for remission induction in severe AAV may not confer clinical benefit and may be associated with more episodes of infection and higher incidence of diabetes.