PMID- 23615499
OWN - NLM
STAT- MEDLINE
DCOM- 20140310
LR  - 20220317
IS  - 1523-1755 (Electronic)
IS  - 0085-2538 (Linking)
VI  - 84
IP  - 2
DP  - 2013 Aug
TI  - Long-term follow-up of patients with severe ANCA-associated vasculitis comparing 
      plasma exchange to intravenous methylprednisolone treatment is unclear.
PG  - 397-402
LID - 10.1038/ki.2013.131 [doi]
AB  - Patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) 
      requiring dialysis at diagnosis are at risk for developing end-stage renal 
      disease (ESRD) or dying. Short-term results of a trial comparing plasma exchange 
      (PLEX) to intravenous methylprednisolone (IV MeP) suggested PLEX improved renal 
      recovery. Here we conducted long-term follow-up to see if this trend persisted. A 
      total of 137 patients with newly diagnosed AAV and a serum creatinine over 500 
      mumol/l or requiring dialysis were randomized such that 69 received PLEX and 68 
      received IV MeP in addition to cyclophosphamide and oral glucocorticoids. The 
      patients were followed for a median of 3.95 years. In each group there were 35 
      deaths, while 23 PLEX and 33 IV MeP patients developed ESRD. The hazard ratio for 
      PLEX compared to IV MeP for the primary composite outcome of death or ESRD was 
      0.81 (95% confidence interval 0.53-1.23). The hazard ratio for all-cause death 
      was 1.08 with a subhazard ratio for ESRD of 0.64 (95% confidence interval 
      0.40-1.05). Thus, although short-term results with PLEX are encouraging, the 
      long-term benefits remain unclear. Further research is required to determine the 
      role of PLEX in AAV. Given the poor outcomes of patients with severe AAV, 
      improved treatment is urgently needed.
FAU - Walsh, Michael
AU  - Walsh M
AD  - Department of Medicine-Nephrology, St Joseph's Hospital, McMaster University, 
      Hamilton, Ontario, Canada. lastwalsh1975@gmail.com
FAU - Casian, Alina
AU  - Casian A
FAU - Flossmann, Oliver
AU  - Flossmann O
FAU - Westman, Kerstin
AU  - Westman K
FAU - Hoglund, Peter
AU  - Hoglund P
FAU - Pusey, Charles
AU  - Pusey C
FAU - Jayne, David R W
AU  - Jayne DR
CN  - European Vasculitis Study Group (EUVAS)
LA  - eng
SI  - ClinicalTrials.gov/NCT01408836
SI  - ISRCTN/ISRCTN52952998
GR  - Canadian Institutes of Health Research/Canada
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130424
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
RN  - 0 (Biomarkers)
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunosuppressive Agents)
RN  - 8N3DW7272P (Cyclophosphamide)
RN  - AYI8EX34EU (Creatinine)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - IM
CIN - Nat Rev Nephrol. 2013 Aug;9(8):436-8. PMID: 23797203
MH  - Administration, Intravenous
MH  - Administration, Oral
MH  - Aged
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated 
      Vasculitis/blood/complications/diagnosis/drug therapy/mortality/*therapy
MH  - Biomarkers/blood
MH  - Creatinine/blood
MH  - Cyclophosphamide/administration & dosage
MH  - Disease Progression
MH  - Drug Therapy, Combination
MH  - Europe
MH  - Female
MH  - Glucocorticoids/*administration & dosage/adverse effects
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage/adverse effects
MH  - Kaplan-Meier Estimate
MH  - Kidney Failure, Chronic/etiology/mortality/therapy
MH  - Male
MH  - Methylprednisolone/*administration & dosage/adverse effects
MH  - Middle Aged
MH  - *Plasma Exchange/adverse effects/mortality
MH  - Proportional Hazards Models
MH  - Renal Dialysis
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Up-Regulation
EDAT- 2013/04/26 06:00
MHDA- 2014/03/13 06:00
CRDT- 2013/04/26 06:00
PHST- 2012/06/15 00:00 [received]
PHST- 2013/01/22 00:00 [revised]
PHST- 2013/01/31 00:00 [accepted]
PHST- 2013/04/26 06:00 [entrez]
PHST- 2013/04/26 06:00 [pubmed]
PHST- 2014/03/13 06:00 [medline]
AID - S0085-2538(15)55947-4 [pii]
AID - 10.1038/ki.2013.131 [doi]
PST - ppublish
SO  - Kidney Int. 2013 Aug;84(2):397-402. doi: 10.1038/ki.2013.131. Epub 2013 Apr 24.