Vasculitis & polymyalgia rheumatica
Risk of Relapse of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis in a Randomized Controlled Trial of Plasma Exchange and Glucocorticoids
Authors' conclusion
In patients with severe ANCA-associated vasculitis, relapses remain common; neither the use of PLEX nor an initial glucocorticoid tapering regimen impacted relapse risk.
Study context
- Population
- Participants with severe AAV enrolled in an international factorial RCT649 achieved remission
- Participants
- 704 participants
- Comparison
- Plasma exchange (PLEX) vs no PLEX; reduced GC regimen vs standard regimen
- Primary endpoint
- Relapses of any severity
Methodological detailspost hoc analysis, international, two-by-two factorial, competing risk time-to-event models
- Post hoc analysis
- International
- Two-by-two factorial
- Competing risk time-to-event models
Primary result
As reported in the abstract
Relapse of any severity
Subhazard ratio
0.91-0.94
95% CI 0.66–1.31
PLEX vs No PLEX
Subhazard ratio
0.93-0.94
95% CI 0.67–1.35
Reduced GC vs Standard GC
Further findings
Relapse frequency (whole cohort)
- Participants with relapse
- 147 (22.7%)
- Total relapses
- 204
- Relapse rate per 100 patient-years
- 10.3 (95% CI 8.4-12.1)
Predictors of relapse
- PR3-ANCA and nonhemorrhagic respiratory manifestations at trial entry associated with increased relapse risk
- Dialysis at baseline and oral CYC induction associated with lower relapse risk
Original publication
Risk of Relapse of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis in a Randomized Controlled Trial of Plasma Exchange and Glucocorticoids. Arthritis Rheumatol. Published 8 April 2024. doi:10.
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