Low-Dose Intravenous Methylprednisolone in Remission Induction Therapy for ANCA-Associated Vasculitis

Background Glucocorticoids (GCs) remain integral to the management of ANCA-associated vasculitis (AAV), but are associated with significant adverse effects. Recent studies have shown reduced oral GC dosing to be safe and effective; however, data guiding the use of intravenous (IV) methylprednisolone (MTP) are limited. Method A single-center retrospective cohort of patients with AAV were divided into two groups: low-dose GC (patients receiving 250mg of IV MTP, followed by a tapering course of 30mg of prednisolone daily) versus high-dose GC (1.5 g of IVMTP, followed by a tapering course of 40-60 mg of prednisolone daily). Primary outcomes included ESKD and mortality, and secondary outcomes included GC-related toxicity, remission, and relapse rates. This study was applied to patients with newly diagnosed AAV, including those with severe or life-threatening disease. Results Sixty-five patients were included in the final analysis-34 in the high-dose treatment group and 31 in the low-dose treatment group. At diagnosis, more advanced renal impairment and histological disease were present in the low-dose cohort. The rate of ESKD was similar between the groups at 6 and 12 months (P 5 0.22, P 5 0.60, respectively). More deaths occurred in the high-dose group (26.5% versus 6.5%, P 5 0.05), although this was not significant on multivariable analysis (P 5 0.06). Remission rates were comparable, and there was no significant difference in relapses. Adverse events were seen in both groups, but patients in the high-dose group experienced a higher incidence of severe infections, weight gain, and steroid-induced diabetes. Conclusion We demonstrate that a markedly reduced dose of IV MTP with a lower overall cumulative dose of GCs is safe and effective in the management of severe AAV disease, with no significant difference in primary outcomes.