Friday, 03 Apr 2020

You are here

PEXIVAS - Plasma Exhange Fails to Boost Outcomes in Severe AAV

Patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis may have severe or life-threatening disease. It is unknown if ther addition of aggressve plasma exchange therapy can signficantly improve outocomes.

The PEXIVAS randomized control trial addressed this question and showed that plasma exchange did not reduce the incidence of death or ESKD. A reduced-dose regimen of glucocorticoids was noninferior to a standard-dose regimen with respect to death or end-stage kidney disease (ESKD). 

This trial evaluated 352 patients with severe ANCA-associated vasculitis (defined as a GFR <50 cc or diffuse pulmonary hemorrhage). Patients were given 2 different regimens of glucocorticoids and then randomlized to seven plasma exchanges for 14 days or no plasma exchange.  Patients were followed for up to 7 years for the primary composite outcome of death from any cause or ESKD.

Death or ESKD occurred in 28% in the plasma-exchange group and in 31% in the control group (hazard ratio, 0.86; 95% confidence interval [CI], 0.65 to 1.13; P=0.27).

Death from any cause or ESKD occurred in 28% in the reduced-dose steroid group and in 25.5% of the standard-dose steroid group, which met the criterion for noninferiority.

Serious infections at 1 year were less common in the reduced-dose group than in the standard-dose group (incidence rate ratio, 0.69; 95% CI, 0.52 to 0.93), but other secondary outcomes were similar in the two groups.

In those with severe ANCA-associated vasculitis, the use of plasma exchange did not alter the outcomes of death or ESKD.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

In Lupus, Keep BP Below 130/80

Blood pressure should be maintained at a level below 130/80 mm Hg in all patients with lupus to lessen their likelihood of atherosclerotic vascular events, Canadian researchers asserted.

In Vasculitis, Beware of Infection

Risks of infection were strikingly high among patients with antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis, which may relate to both the disease and its treatment, Scottish researchers found.

Malignancies with Giant Cell Arteritis

The Journal of Rheumatology reports the findings of a Swedish population-based cohort study of biopsy-proven giant cell arteritis (GCA) patients showing that the overall risk for cancer was not increased; yet there appears to be an increased risk for leukemia and a decreased risk for breast and upper gastrointestinal tract cancers.   

Hospitalized GPA - Higher morbidity, Mortality and Cost

Rheumatology reports on a study of patients with granulomatosis with polyangiitis (GPA) showing worse outcomes and higher costs when hospitalized with GPA.

GPA patients were identified from the Nationwide Inpatient Sample (NIS) and were compared to those without GPA with regard to demographics, procedures, length of stay, mortality, morbidity and total hospitalization charges (between 2005–2014).

Don't Blame the Weather in Sjogren's

Seasonal variations in symptoms -- commonly reported by patients with rheumatic diseases -- were not observed in a large cohort of patients with primary Sjogren's syndrome, French investigators found.