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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Benefits of an expanded use of plasma exchange for anti-neutrophil cytoplasmic antibody-associated vasculitis within a dedicated clinical service

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Neeraj Dhaun, Andrew Saunders, Christopher O. Bellamy, Rocío Martinez Gallardo, Lynn Manson, David C. Kluth
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-015-0796-7) contains supplementary material, which is available to authorized users.

Competing interests

None of the authors have a conflict of interest.

Authors’ contributions

ND: conception and design, data collection and analysis, manuscript writing and final approval of the manuscript. AS: data collection and analysis, critical revision and final approval of the manuscript. COB: data collection and analysis, critical revision and final approval of the manuscript. RMG: data collection and analysis and final approval of the manuscript. LM: data analysis and final approval of the manuscript. DCK: conception and design, manuscript writing, final approval of manuscript. All authors read and approved the final manuscript.

Abstract

Background

Current recommendations for ANCA-associated vasculitis (AAV) support its management within a dedicated clinical service. Therapies for AAV are imperfect with many patients failing to achieve disease control and others experiencing disease relapse. Plasma exchange (PEX) may be beneficial especially when the kidney is involved.

Methods

Within a new, dedicated service we retrospectively assessed, over a 6-year period, the benefits of PEX in two patient cohorts, discriminated by PEX treatment alone. Patients received PEX alongside standard of care if they fulfilled any of the following criteria: 1. serum creatinine >500 μmol/l or dialysis-requiring renal failure, 2. alveolar haemorrhage, 3. renal biopsy showing ≥30 % focal and necrotising lesions ± cellular crescents. Outcome measures included disease remission and relapse, cumulative immunosuppression, and morbidity and mortality.

Results

Of 104 new patients, 58 patients received PEX at presentation, 46 did not. Cyclophosphamide and/or rituximab dosing was similar for both groups. Although patients receiving PEX had poorer renal function, a higher C-reactive protein and disease activity score at presentation disease remission rate was similar in both groups (no PEX vs. PEX: 96 % vs. 98 %). The PEX group entered remission quicker (no PEX vs. PEX: 3.9 ± 4.0 vs. 2.8 ± 1.3 months, p < 0.05), with a lower 3-month cumulative glucocorticoid dose (no PEX vs. PEX: 2.5 ± 0.4 vs. 2.3 ± 0.2 g, p < 0.001). Relapse was similar between groups but adverse events lower in the PEX group.

Conclusions

PEX may be of benefit in AAV. Larger, longer randomised controlled trials are now needed.
Zusatzmaterial
Additional file 1: Supplementary Methods. Table S1. Comparison of patients receiving rituximab or cyclophosphamide (CYC) for induction. Data are shown as number of patients (%), mean ± standard deviation or median and IQR. Table S2. Comparison of rituximab dosing, cumulative glucocorticoid dose at 3 months, remission, relapse and survival in patients <70 and ≥70 years of age. Data are shown as number of patients (%), mean ± standard deviation or median and IQR. (DOCX 114 kb)
12891_2015_796_MOESM1_ESM.docx
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