A RECENT real-world study highlights the challenges of using the reduced-dose glucocorticoid regimen (redGC) from the PEXIVAS trial for treating antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The study suggests that redGC may increase the risk of adverse outcomes, including disease progression and relapse, particularly in patients treated with rituximab (RTX).
The multicentre, retrospective study compared outcomes for 234 AAV patients receiving either redGC or standard-dose glucocorticoid (standGC) therapy. The primary composite outcome included death, end-stage kidney disease (ESKD), disease progression before remission, or relapse within 12 months.
Results showed that the primary outcome occurred in 33% of patients in the redGC group compared to 19% in the standGC group. Weighted and unweighted analyses confirmed an independent association between redGC and the primary outcome, though redGC was not specifically linked to death or ESKD. Patients with high serum creatinine levels (>300 µmol/L) and those receiving RTX were particularly vulnerable, showing a higher likelihood of relapse, disease progression, or adverse outcomes.
These findings raise concerns about applying the redGC regimen in clinical practice, especially for patients treated with RTX. While redGC may reduce the risk of steroid-related complications, it appears less effective in preventing disease progression or relapse, highlighting the need for personalised treatment approaches in AAV.
Reference
Nagle S et al. Real-life use of the PEXIVAS reduced-dose glucocorticoid regimen in granulomatosis with polyangiitis and microscopic polyangiitis Ann Rheum Dis. 2024;DOI: 10.1136/ard-2024-226339.
