Real-life use of the PEXIVAS reduced-dose glucocorticoid regimen in granulomatosis with polyangiitis and microscopic polyangiitis
Sophie Nagle
(1)
,
Yann Nguyen
(2)
,
Mary-Jane Guerry
(3)
,
Thomas Quemeneur
(4)
,
Dimitri Titeca-Beauport
(5, 6)
,
Thomas Crépin
(7, 8)
,
Rafik Mesbah
(9)
,
Idris Boudhabhay
(10, 11)
,
Grégory Pugnet
(12)
,
Céline Lebas
(13)
,
Antoine Néel
(14, 15)
,
Alexandre Karras
(16)
,
Eric Hachulla
(17)
,
Juliette Woessner
(18)
,
Vincent Pestre
(18)
,
Raphaël Borie
(19, 20)
,
Stephane Vinzio
(21)
,
Jean-Baptiste Gouin
(22)
,
Sara Melboucy-Belkhir
(23)
,
Roderau Outh
(24)
,
Benjamin Subran
,
Mathieu Gerfaud-Valentin
(25)
,
Sebastien Humbert
,
Philippe Kerschen
,
Yurdagul Uzunhan
(26, 27)
,
Tiphaine Goulenok
(19)
,
Maxime Beydon
(28)
,
Nathalie Costedoat-Chalumeau
(1)
,
Xavier Puechal
(1)
,
Benjamin Terrier
(1, 10)
1
Hôpital Cochin [AP-HP]
2 Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre
3 CHV - Centre Hospitalier de Valenciennes
4 Centre hospitalier [Valenciennes, Nord]
5 CHU Amiens-Picardie
6 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517
7 Service d'urologie, andrologie et transplantation rénale
8 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
9 Centre Hospitalier Boulogne-sur-mer
10 UPCité - Université Paris Cité
11 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
12 Service Médecine Interne et immunologie clinique [CHU Toulouse]
13 Service de Néphrologie et Transplantation rénale [CHRU-lille]
14 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
15 Team 4 - U1064 Inserm - CR2TI - Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t)
16 HEGP - Hôpital Européen Georges Pompidou [APHP]
17 Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord Ouest [CHRU Lille]
18 Centre Hospitalier Henri Duffaut (Avignon)
19 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
20 PHERE (UMR_S_1152 / U1152) - Physiopathologie et Epidémiologie des Maladies Respiratoires
21 GHM - Groupe Hospitalier Mutualiste [Grenoble]
22 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
23 Hôpital Jean Verdier [AP-HP]
24 Centre Hospitalier Saint Jean de Perpignan
25 Centre hospitalier Saint Joseph - Saint Luc [Lyon]
26 Avicenne Hospital, AP-HP, Bobigny
27 Université Sorbonne Paris Nord
28 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre
3 CHV - Centre Hospitalier de Valenciennes
4 Centre hospitalier [Valenciennes, Nord]
5 CHU Amiens-Picardie
6 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517
7 Service d'urologie, andrologie et transplantation rénale
8 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
9 Centre Hospitalier Boulogne-sur-mer
10 UPCité - Université Paris Cité
11 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
12 Service Médecine Interne et immunologie clinique [CHU Toulouse]
13 Service de Néphrologie et Transplantation rénale [CHRU-lille]
14 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
15 Team 4 - U1064 Inserm - CR2TI - Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t)
16 HEGP - Hôpital Européen Georges Pompidou [APHP]
17 Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord Ouest [CHRU Lille]
18 Centre Hospitalier Henri Duffaut (Avignon)
19 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
20 PHERE (UMR_S_1152 / U1152) - Physiopathologie et Epidémiologie des Maladies Respiratoires
21 GHM - Groupe Hospitalier Mutualiste [Grenoble]
22 CHBA - Centre hospitalier Bretagne Atlantique (Morbihan)
23 Hôpital Jean Verdier [AP-HP]
24 Centre Hospitalier Saint Jean de Perpignan
25 Centre hospitalier Saint Joseph - Saint Luc [Lyon]
26 Avicenne Hospital, AP-HP, Bobigny
27 Université Sorbonne Paris Nord
28 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
Sophie Nagle
- Fonction : Auteur
- PersonId : 1446308
- ORCID : 0000-0002-5859-5524
Yann Nguyen
- Fonction : Auteur
- PersonId : 768771
- ORCID : 0000-0002-0866-3824
Raphaël Borie
- Fonction : Auteur
- PersonId : 770718
- ORCID : 0000-0002-9906-0024
- IdRef : 081295626
Benjamin Subran
- Fonction : Auteur
Sebastien Humbert
- Fonction : Auteur
Philippe Kerschen
- Fonction : Auteur
Maxime Beydon
- Fonction : Auteur
- PersonId : 1300249
- IdHAL : maxime-beydon
- ORCID : 0000-0003-4924-093X
Xavier Puechal
- Fonction : Auteur
- PersonId : 756835
- ORCID : 0000-0003-3573-9203
- IdRef : 083261885
Benjamin Terrier
- Fonction : Auteur
- PersonId : 762205
- ORCID : 0000-0001-6612-7336
- IdRef : 13141142X
Résumé
Background The PEXIVAS (Plasma exchange and glucocorticoids in severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis) trial showed that a reduced-dose glucocorticoid regimen (redGC) was non-inferior to a standard-dose regimen (standGC) with respect to death or end-stage kidney disease (ESKD) in patients with ANCA-associated vasculitis (AAV). However, the primary endpoint did not include disease progression or relapse, cyclophosphamide was the main induction therapy and rituximab (RTX)-treated patients tended to have a higher risk of death or ESKD with redGC. We aimed to evaluate the real-world use of redGC. Methods We conducted a retrospective, multicentre study comparing PEXIVAS redGC with standGC in patients with AAV. The primary composite outcome was the occurrence of death, ESKD, AAV progression before remission or relapse within the 12 months following induction. Inverse probability of treatment weighting was used to correct for baseline imbalance between groups. Factors associated with the occurrence of the primary outcome were estimated. Results A total of 234 patients were included. The primary composite outcome occurred in 42/126 (33%) patients with redGC versus 20/108 (19%) with standGC. In unweighted multivariable analysis and in weighted analysis, redGC was independently associated with the primary outcome but not with death or ESKD. Among redGC-treated patients, those with serum creatinine>300 µmol/L were more likely to achieve the primary outcome. RTX-treated patients who received redGC were more likely to experience death or ESKD and to achieve the primary outcome. Conclusion In this study of patients with AAV primarily treated with RTX, redGC was associated with an increased risk of the primary outcome consisting of death, ESKD, AAV progression before remission or relapse.