Prolonged Glucocorticoid Use May Prevent Vasculitis Relapse

Major finding: The relapse rate for patients with antineutrophil cytoplasmic antibody–associated vasculitis was 43% in a pooled analysis of studies in which patients were tapered completely from glucocorticoids, compared with 14% in studies of patients allowed to continue glucocorticoid therapy. Early discontinuation was associated with a higher relapse rate than was later discontinuation.

Data Source: Meta-analysis of 13 studies involving 983 patients investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering.

Disclosures: Dr. Yazici has served as a consultant or speaker for, or has received research support from, BMS, Celgene, Centocor, Genentech, Merck, Novartis, Roche, and UCB.

NEW YORK – Early discontinuation of glucocorticoid therapy may greatly increase the risk of relapse in antineutrophil cytoplasmic antibody–associated vasculitis, said Dr. Yusuf Yazici.

He discussed a study that addressed the controversial question of whether low-dose glucocorticoids contribute to maintaining remission of the disease.

Patients successfully treated for antineutrophil cytoplasmic antibody–associated vasculitis (AAV) face high rates of relapse, up to 38% at 30 months. Although glucocorticoids are often used to prevent relapse in AAV, high-quality evidence to guide treatment is lacking, Dr. Yazici said.

“Our aim is always to get patients off steroid therapy, but maybe that is a misguided aim,” said Dr. Yazici, director of the Seligman Center for Advanced Therapeutics and Behçet's Syndrome Evaluation, Treatment and Research Center at the New York University Hospital for Joint Diseases.

Dr. Yazici cited findings from a meta-analysis of studies investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering (Arthritis Care Res. 2010;62:1166-73). Thirteen studies involving 983 patients were identified for inclusion, including five observational and eight randomized controlled trials. None of the studies directly compared glucocorticoid regimens.

To elucidate the role of glucocorticoid therapy in relapse, the authors divided the studies into those that had a zero glucocorticoid target dose (aimed to get patients completely off glucocorticoid therapy, n = 695) and those having a nonzero glucocorticoid target dose (low glucocorticoid maintenance dose allowed, n = 288).

The investigators found that 36% of the overall group relapsed. Upon further examination, the relapse rate was 43% for those in the zero glucocorticoid target dose group, compared with 14% in those allowed to continue glucocorticoids – approximately a threefold increase.

Even for those who discontinue glucocorticoids, timing is important. When the investigators divided patients in the zero target dose into those who had to reach zero within 12 months (the early zero group) and those who were allowed to reach zero after 12 months (the late zero group), there was a 48% relapse rate for the early zero group, compared with a 29% rate for the late zero group. While the early zero glucocorticoid target dose group had significantly more relapses than the nonzero group (P less than .001), the late zero glucocorticoid target dose group was similar to the nonzero group. By grouping the late zero and nonzero groups, the authors concluded that early discontinuation of glucocorticoid was associated with a 20% increased risk of relapse (28% vs. 48%).

The results suggest that glucocorticoid dose should be monitored, and that patients with AAV should be kept on 5.0–7.5 mg of glucocorticoids for at least a year after reaching remission, said Dr. Yazici.

Major finding: The relapse rate for patients with antineutrophil cytoplasmic antibody–associated vasculitis was 43% in a pooled analysis of studies in which patients were tapered completely from glucocorticoids, compared with 14% in studies of patients allowed to continue glucocorticoid therapy. Early discontinuation was associated with a higher relapse rate than was later discontinuation.

Data Source: Meta-analysis of 13 studies involving 983 patients investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering.

Disclosures: Dr. Yazici has served as a consultant or speaker for, or has received research support from, BMS, Celgene, Centocor, Genentech, Merck, Novartis, Roche, and UCB.

NEW YORK – Early discontinuation of glucocorticoid therapy may greatly increase the risk of relapse in antineutrophil cytoplasmic antibody–associated vasculitis, said Dr. Yusuf Yazici.

He discussed a study that addressed the controversial question of whether low-dose glucocorticoids contribute to maintaining remission of the disease.

Patients successfully treated for antineutrophil cytoplasmic antibody–associated vasculitis (AAV) face high rates of relapse, up to 38% at 30 months. Although glucocorticoids are often used to prevent relapse in AAV, high-quality evidence to guide treatment is lacking, Dr. Yazici said.

“Our aim is always to get patients off steroid therapy, but maybe that is a misguided aim,” said Dr. Yazici, director of the Seligman Center for Advanced Therapeutics and Behçet's Syndrome Evaluation, Treatment and Research Center at the New York University Hospital for Joint Diseases.

Dr. Yazici cited findings from a meta-analysis of studies investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering (Arthritis Care Res. 2010;62:1166-73). Thirteen studies involving 983 patients were identified for inclusion, including five observational and eight randomized controlled trials. None of the studies directly compared glucocorticoid regimens.

To elucidate the role of glucocorticoid therapy in relapse, the authors divided the studies into those that had a zero glucocorticoid target dose (aimed to get patients completely off glucocorticoid therapy, n = 695) and those having a nonzero glucocorticoid target dose (low glucocorticoid maintenance dose allowed, n = 288).

The investigators found that 36% of the overall group relapsed. Upon further examination, the relapse rate was 43% for those in the zero glucocorticoid target dose group, compared with 14% in those allowed to continue glucocorticoids – approximately a threefold increase.

Even for those who discontinue glucocorticoids, timing is important. When the investigators divided patients in the zero target dose into those who had to reach zero within 12 months (the early zero group) and those who were allowed to reach zero after 12 months (the late zero group), there was a 48% relapse rate for the early zero group, compared with a 29% rate for the late zero group. While the early zero glucocorticoid target dose group had significantly more relapses than the nonzero group (P less than .001), the late zero glucocorticoid target dose group was similar to the nonzero group. By grouping the late zero and nonzero groups, the authors concluded that early discontinuation of glucocorticoid was associated with a 20% increased risk of relapse (28% vs. 48%).

The results suggest that glucocorticoid dose should be monitored, and that patients with AAV should be kept on 5.0–7.5 mg of glucocorticoids for at least a year after reaching remission, said Dr. Yazici.

Major finding: The relapse rate for patients with antineutrophil cytoplasmic antibody–associated vasculitis was 43% in a pooled analysis of studies in which patients were tapered completely from glucocorticoids, compared with 14% in studies of patients allowed to continue glucocorticoid therapy. Early discontinuation was associated with a higher relapse rate than was later discontinuation.

Data Source: Meta-analysis of 13 studies involving 983 patients investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering.

Disclosures: Dr. Yazici has served as a consultant or speaker for, or has received research support from, BMS, Celgene, Centocor, Genentech, Merck, Novartis, Roche, and UCB.

NEW YORK – Early discontinuation of glucocorticoid therapy may greatly increase the risk of relapse in antineutrophil cytoplasmic antibody–associated vasculitis, said Dr. Yusuf Yazici.

He discussed a study that addressed the controversial question of whether low-dose glucocorticoids contribute to maintaining remission of the disease.

Patients successfully treated for antineutrophil cytoplasmic antibody–associated vasculitis (AAV) face high rates of relapse, up to 38% at 30 months. Although glucocorticoids are often used to prevent relapse in AAV, high-quality evidence to guide treatment is lacking, Dr. Yazici said.

“Our aim is always to get patients off steroid therapy, but maybe that is a misguided aim,” said Dr. Yazici, director of the Seligman Center for Advanced Therapeutics and Behçet's Syndrome Evaluation, Treatment and Research Center at the New York University Hospital for Joint Diseases.

Dr. Yazici cited findings from a meta-analysis of studies investigating the treatment of AAV that included a predefined glucocorticoid dose and protocol for tapering (Arthritis Care Res. 2010;62:1166-73). Thirteen studies involving 983 patients were identified for inclusion, including five observational and eight randomized controlled trials. None of the studies directly compared glucocorticoid regimens.

To elucidate the role of glucocorticoid therapy in relapse, the authors divided the studies into those that had a zero glucocorticoid target dose (aimed to get patients completely off glucocorticoid therapy, n = 695) and those having a nonzero glucocorticoid target dose (low glucocorticoid maintenance dose allowed, n = 288).

The investigators found that 36% of the overall group relapsed. Upon further examination, the relapse rate was 43% for those in the zero glucocorticoid target dose group, compared with 14% in those allowed to continue glucocorticoids – approximately a threefold increase.

Even for those who discontinue glucocorticoids, timing is important. When the investigators divided patients in the zero target dose into those who had to reach zero within 12 months (the early zero group) and those who were allowed to reach zero after 12 months (the late zero group), there was a 48% relapse rate for the early zero group, compared with a 29% rate for the late zero group. While the early zero glucocorticoid target dose group had significantly more relapses than the nonzero group (P less than .001), the late zero glucocorticoid target dose group was similar to the nonzero group. By grouping the late zero and nonzero groups, the authors concluded that early discontinuation of glucocorticoid was associated with a 20% increased risk of relapse (28% vs. 48%).

The results suggest that glucocorticoid dose should be monitored, and that patients with AAV should be kept on 5.0–7.5 mg of glucocorticoids for at least a year after reaching remission, said Dr. Yazici.