Plasma exchange & Glucocorticoids in severe ANCA-associated
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More effective and safer treatments are needed for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis.

Researchers conducted the PEXIVAS trial in patients with severe ANCA-associated vasculitis to compare the efficacy of plasma exchange with no plasma exchange with respect to death or ESKD.

A randomized trial with a 2-by-2 factorial design to evaluate the use of plasma exchange and two regimens of oral glucocorticoids in patients with severe ANCA-associated vasculitis (defined by an estimated glomerular filtration rate of <50 ml per minute per 1.73 m2 of body-surface area or diffuse pulmonary hemorrhage).

Death from any cause or ESKD occurred in 100 of 352 patients (28.4%) in the plasma-exchange group and in 109 of 352 patients (31.0%) in the control group. The results were similar in subgroup analyses and in analyses of secondary outcomes. Researchers also assessed the noninferiority of a reduced-dose regimen of glucocorticoids to a standard-dose regimen, using a noninferiority margin of 11 percentage points. Death from any cause or ESKD occurred in 92 of 330 patients (27.9%) in the reduced-dose group and in 83 of 325 patients (25.5%) in the standard-dose group, which met the criterion for noninferiority.

Conclusively, among patients with severe ANCA-associated vasculitis, the use of plasma exchange did not reduce the incidence of death or ESKD. A reduced-dose regimen of glucocorticoids was noninferior to a standard-dose regimen with respect to death or ESKD.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1803537?query=featured_home
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