Plasma exchange fails to reduce death, end-stage kidney dise
Plasma exchange did not reduce the incidence of death or end-stage kidney disease among patients with antineutrophil cytoplasmic antibody-associated vasculitis, according to data published in The New England Journal of Medicine.

Researchers also found that, among these patients, a reduced-dose regimen of glucocorticoids was noninferior to a standard-dose plan regarding death or end-stage kidney disease.

The rapid removal of antineutrophil cytoplasmic antibodies [ ANCAs] by means of plasma exchange may reduce organ damage from ANCA-associated vasculitis,However, the effect of plasma exchange added to immunosuppressive therapy as compared with immunosuppressive therapy alone on clinically important outcomes, such as death and ESKD, is uncertain.

High-dose glucocorticoids were the first treatments found to be effective in ANCA-associated vasculitis, and they remain a cornerstone of disease management,However, glucocorticoids have numerous dose-dependent adverse effects, and high-quality data are lacking regarding an effective and relatively safe rate at which glucocorticoid doses can be tapered in patients with ANCA-associated vasculitis.

The PEXIVAS study was conducted to analyze the impact of plasma exchange and two other regimens of oral glucocorticoids on the incidence of death and end-stage kidney disease on patients with ANCA-associated vasculitis. The randomized controlled trial, with a 2-by-2 factorial design, included 704 patients from 16 countries, aged 15 years or older, with new or relapsing granulomatosis with polyangiitis or microscopic polyangiitis. All participants also had a history of positive myeloperoxidase or proteinase 3 antibodies, as well as kidney involvement.

Investigators randomly assigned participants were in a 1:1:1:1 ratio to one of four treatment groups. According to the researchers, any-cause death or end-stage kidney disease occurred in 28.4% of participants in the plasma-exchange group and in 31% of those in the non-exchange group . Further, death from any cause or end-stage kidney disease occurred in 27.9% of participants treated with a reduced-dose glucocorticoid regimen, compared with 25.5% in the standard-dose group, representing an absolute risk difference of 2.3 percentage points, which met the criterion for noninferiority..

Trial in patients with severe ANCA-associated vasculitis showed that plasma exchange did not result in a lower incidence of death or ESKD than no plasma exchange.Reduced exposure to oral glucocorticoids was noninferior to a standard-dose regimen with respect to the risk of death or ESKD and resulted in a lower risk of serious infections in the first year of treatment.