medwireNews: Clinical practice guidelines have been developed to advise on the role of plasma exchange and the optimal dose of glucocorticoids in people with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis.
“This clinical practice guideline was triggered by publication of the PEXIVAS randomised controlled trial,” say Linan Zeng (Sichuan University, Chengdu, China) and co-authors. In this trial, the addition of plasma exchange to standard therapy did not reduce the risk for all-cause mortality or end-stage renal disease (ESRD), but a reduced-dose regimen of glucocorticoids was found to decrease the risk for serious infections relative to a standard-dose regimen.
Furthermore, Zeng and team say that an updated systematic review and meta-analysis found that plasma exchange is associated with a reduced risk for ESRD but an increased risk for serious infections in people with ANCA-associated vasculitis, while a second systematic review found that reduced-dose glucocorticoid regimens may reduce the risk for serious infection or death.
On the basis of this evidence, the guidelines include a weak recommendation against plasma exchange in people with a low or low-moderate risk for developing ESRD, a weak recommendation for plasma exchange in those with a moderate-high or high risk, and a strong recommendation for using a reduced-dose glucocorticoid regimen for the first 6 months of therapy.
“The recommendations were made with the understanding that patients would place a high value on reduction in ESKD and less value on avoiding serious infections,” write Zeng et al in The BMJ.
They acknowledge, however, that there is likely a “large variation in patients’ values and preferences regarding the tradeoff between benefits […] and harms.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group