Abstract: SA-PO255

The Steroid Tapering in ANCA Vasculitis Evaluation Study (STAVE) 2: A Systematic Review and Meta-Analysis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Rodrigues, Jennifer C., McMaster University, Toronto, Ontario, Canada
  • Collister, David Thomas, McMaster University, Toronto, Ontario, Canada
  • Archer, Amy, Northwestern University, Chicago, Illinois, United States
  • Cheema, Kim P., University of Calgary, Calgary, Alberta, Canada
  • Pagnoux, Christian, Mount Sinai Hospital, Toronto, Ontario, Canada
  • Thabane, Lehana, McMaster University, Hamilton, Ontario, Canada
  • Merkel, Peter A., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Jayne, David R.W., University of Cambridge, Cambridge, United Kingdom
  • Walsh, Michael, McMaster University, Toronto, Ontario, Canada
Background

Relapses of ANCA-associated vasculitis (AAV) are associated with death, decreased renal function, and ESRD. The role of glucocorticoids (GC) in relapse prevention is unclear.

Methods

MEDLINE, EMBASE, Cochrane Clinical Trials, and Grey Literature were searched from January 1, 2008 until May 26, 2016 without language restriction for studies with patients with AAV. GC use was specified a priori with minimum follow up of 18 months. Randomized controlled trials (RCT) and prospective cohort studies were included. Quality of evidence was assessed using modified Newcastle-Ottawa criteria. Meta-analysis was completed using a random-effects model of DerSimonian and Laird.

Results

24 studies met criteria with 2272 patients. 13 (54%) discontinued GC in < 1 year. The pooled relapse rate was 14.3 per 100 patient years (95% CI 4.5,24.0). Relapse was more frequent when discontinuation was compared to long-term, low-dose GC (20.7 per 100 patient years, 95% CI 6.8,34.5 vs. 8.0 per 100 patient years, 95% CI 5.7,21.7 Figure 1). Multivariable linear meta-regression confirmed that long-term, low-dose GC was associated with lower relapse rates (β = -0.16, 95% CI -0.26,0.07, P = 0.001) and follow up time was associated with increased relapse rates (β = 0.003, 95% CI 0.001,0.006, P = 0.002). Multivariable linear meta-regression did not demonstrate any association of GC dosing with infections.

Conclusion

Long-term, low-dose GC was associated with decreased relapse rates in patients with AAV. Characterization and reporting of adverse events limited analysis. RCT are needed to determine optimal GC administration.

Random effects meta-analysis of long-term, low dose GC as compared to GC discontinuation on relapse per patient year.

Funding

  • Private Foundation Support