Vasculitis & polymyalgia rheumatica
Effectiveness of intravenous methylprednisolone pulse in patients with severe microscopic polyangiitis and granulomatosis with polyangiitis
Authors' conclusion
IVMP 1.0 g/day pulse may improve 48-week mortality in patients with severe MPA/GPA.
Study context
- Population
- Patients with severe microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) (severe glomerulonephritis or diffuse alveolar haemorrhage), nationwide registry in JapanMPA, 175
- Participants
- 201 patients
- Exposure
- Intravenous methylprednisolone (IVMP) 0.5 g/day vs IVMP 1.0 g/day vs non-IVMP
- Outcome
- All-cause mortality
- Follow-up
- 2 to 48 weeks after treatment initiation
Methodological detailsnationwide registry, propensity score-based overlap weighting, Cox proportional hazard model, Fine-Gray subdistribution hazard model
- Nationwide registry
- Propensity score-based overlap weighting
- Cox proportional hazard model
- Fine-Gray subdistribution hazard model
Main finding
As reported in the abstract
2 to 48 weeks
Each group vs Non-IVMPHazard ratio (95% CI)
IVMP 0.5 g/day
0.46(0.07–2.81)
IVMP 1.0 g/day
0.07(0.01–0.41)
- Deaths, all patients
- 6 (3%)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Estimate | |
|---|---|---|
| Composite all-cause mortality/kidney failure · 2 to 48 weeksIVMP 0.5 g/dayvs Non-IVMP | HR 1.18 (95% CI 0.26–5.31) | |
| Composite all-cause mortality/kidney failure · 2 to 48 weeksIVMP 1.0 g/dayvs Non-IVMP | HR 0.59 (95% CI 0.08–4.52) | |
| Severe relapse · 2 to 48 weeksIVMP 0.5 g/dayvs Non-IVMP | subdistribution HR 1.26 (95% CI 0.12–13.70) | |
| Severe relapse · 2 to 48 weeksIVMP 1.0 g/dayvs Non-IVMP | subdistribution HR 3.36 (95% CI 0.49–23.29) | |
| 0.050.21520Ratio (log scale) |
- Composite all-cause mortality/kidney failure — Kidney failure, all patients
- 4 (2.0%)
- Severe relapse — Severe relapse, all patients
- 11 (5.5%)
Safety
| Outcome | Subdistribution HR (95% CI) | |
|---|---|---|
| Serious infection · 2 to 48 weeksIVMP 0.5 g/dayvs Non-IVMP | 1.88 (0.76–4.65) | |
| Serious infection · 2 to 48 weeksIVMP 1.0 g/dayvs Non-IVMP | 0.94 (0.28–3.13) | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
- Serious infection — Severe infections, all patients
- 40 (19.9%)
Original publication
Effectiveness of intravenous methylprednisolone pulse in patients with severe microscopic polyangiitis and granulomatosis with polyangiitis. Rheumatology (Oxford). Published 12 April 2024. doi:10.
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