Vasculitis & polymyalgia rheumatica
No benefit of adding glucocorticoids to maintenance treatment in reducing the risk of major relapses in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis: real life data from a longitudinal cohort study
Authors' conclusion
Higher GC exposure during maintenance therapy was not significantly associated with a lower major relapse risk whereas it was associated with damage accrual and hospitalisation.
Study context
- Population
- Newly diagnosed patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) on maintenance therapy, three tertiary referral centres (median age 61 years)803.4 patient years
- Participants
- 171 participants
- Exposure
- Low-dose GC exposure during maintenance therapy
- GPAn = 107
- MPAn = 64
- Outcome
- Major relapse (BVAS increase >0) during maintenance therapy
Methodological detailsmulticentre (three tertiary referral centres), time-varying and mixed-effects Cox models, sensitivity analysis for potential confounding, Median follow-up 88.2 months
- Multicentre (three tertiary referral centres)
- Time-varying and mixed-effects Cox models
- Sensitivity analysis for potential confounding
- Median follow-up 88.2 months
Main finding
As reported in the abstract
Major relapse risk with low-dose GCs
Low-dose glucocorticoids (GCs), HR for major relapse
0.96
95% CI 0.88 to 1.05p=0.36
Major relapses, n (rate per 100 patient years (PY)); 48 patients (28%) relapsed
65
8.1/100 PY
Observational data: associations, not effects.
Further findings
Predictors of major relapse
- Rituximab use, HR
- 0.21 (95% CI 0.09 to 0.47, p=0.0001)
- Disease activity at diagnosis, HR
- 1.17 (95% CI 1.03 to 1.33, p=0.013)
- Multivariable analysis
Damage accumulation (Vasculitis Damage Index (VDI) increase) with low-dose GCs
- Low-dose GCs, HR
- 1.52 (95% CI 1.19 to 1.93, p=0.0007)
- New damage events (rate per 100 PY)
- 65 (8.1/100 PY)
Hospitalisations with low-dose GCs
- Low-dose GCs, HR
- 1.24 (95% CI 1.06 to 1.45, p=0.006)
- Hospitalisations (rate per 100 PY)
- 132 (16.4/100 PY)
Original publication
No benefit of adding glucocorticoids to maintenance treatment in reducing the risk of major relapses in ANCA-associated vasculitis: real life data from a longitudinal cohort study. RMD Open. Published 24 June 2026. doi:10.
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