Abstract: FR-PO0823
Meta-Analysis of Safety and Efficacy of Reduced Glucocorticoid Induction Regimens in ANCA-Associated Vasculitis
Session Information
- Glomerular Clinical Trials: From Data to Impact
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ryan, Caoimhe, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Murray, Cian P, Mater Misericordiae University Hospital, Dublin, Leinster, Ireland
- Nic an Riogh, Eithne Muireann, The University of Dublin Trinity College, Dublin, Leinster, Ireland
- Little, Mark Alan, The University of Dublin Trinity College, Dublin, Leinster, Ireland
Group or Team Name
- Trinity Kidney Centre, Trinity Translational Medicine Institute.
Background
Remission induction regimens for ANCA vasculitis (AAV) typically include high-dose glucocorticoids(GC) and are associated with significant toxicity. Steroid-sparing strategies have emerged, including reduced-dose regimens, rapid tapers, foregoing pulsed methylprednisolone, use of combination RTX/CYC or steroid-sparing agents like Avacopan. We systematically reviewed the efficacy and safety of such regimens across diverse study designs and populations
Methods
We searched MEDLINE, EMBASE, and Cochrane from inception to January 2025 for studies assessing steroid-sparing induction in AAV. Outcomes included remission, relapse, mortality, and serious infections. Two reviewers independently screened and extracted data. Due to clinical heterogeneity, we used a mixed-methods synthesis including meta-analysis (Review Manager 5.4)
Results
35 studies were included (4 RCTs, 2 RCT follow-ups, 15 comparative, and 14 single-arm studies). Interventions included reduced GC-dose, rapid GC tapering, IV methylprednisolone omission, avacopan use, and RTX/CYC combination. Median follow-up was 12 months (range of 4.25 to 56.0).
Steroid-sparing regimens showed comparable remission and relapse rates to standard therapies, with signals of lower infection risk and less GC-related adverse events. Pooled incidence of relapse was 14.5% in the GC-sparing group (205/1,417 patients; 95% CI:12.7%–16.4%,I2 = 76.6%). Median follow-up duration was 12 months (range of 4.25 to 56.0 months).Meta-analysis showed no significant differences in remission or relapse between therapy groups (see image). However, odds ratios for mortality, severe infections favoured GC-sparing strategies
Conclusion
Steroid-sparing regimens in AAV appear to maintain treatment efficacy with potential safety benefits. However, substantial heterogeneity limits strong comparative conclusions. Standardised, long-term trials are needed