Presentation: The Effect of Low-Dose Corticosteroids on Risk of Relapse in ANCA-Associated Vasculitis: A Systematic Review and Meta-Analysis of Clinical Trials (2007)

2012 The Effect of Low-Dose Corticosteroids on Risk of Relapse in ANCA-Associated Vasculitis: A Systematic Review and Meta-Analysis of Clinical Trials

Background: Whether use of long-term, low-dose corticosteroids (CS) helps maintain remission of ANCA-associated vasculitis (AAV) remains controversial. We examined this question by conducting a systematic review and meta-analysis of clinical studies of AAV.
Methods: All identified prospective therapeutic studies of Wegener’s granulomatosis or microscopic polyangiitis using a prespecified CS treatment protocol and published after 1995 were included for analysis. We used a random effects model to estimate the pooled proportion of relapses by study end. Meta-regression, generalized linear multilevel modeling, and sensitivity analyses were used to determine sources of heterogeneity in the proportion of relapses.
Results: No studies directly comparing CS regimens were found. Seven randomized control trials and 3 uncontrolled trials with varying CS regimens with a combined total of 895 patients were identified for analyses. Seven studies (580 patients) that attempted to discontinue CS (target of 0 mg/day) and 3 studies 315 patients) continued long-term, low-dose CS (target of 5-7.5 mg/day). The pooled proportion of relapse was 34% (95% CI 24-44%) over a mean follow-up of 22 months. The proportion of relapses was 13% (95% CI 9.5-18%) in those studies continuing low-dose CS compared to 42% (95% CI 32-53%) in studies discontinuing CS. Significant heterogeneity (p<0.001) was present across the studies regarding the proportion of relapses; some of the heterogeneity was accounted for by use or discontinuation of low-dose CS.
Conclusions: Studies of AAV have widely varying proportions of relapse which are, in part, explained by differences in CS tapering regimens. These data suggest that continued low-dose CS may be associated with fewer relapses. Furthermore, the potential impact of the use of low-dose CS should be considered in the design and sample size calculations for clinical trials in AAV.

 M. Walsh, None; P.A. Merkel, None; A.D. Mahr, None; D. Jayne, None.