Glucocorticoid-Related Toxicities Common in ANCA Vasculitis

Glucocorticoid-related adverse effects are common in patients with ANCA-associated vasculitis (AAV), investigators concluded in a presentation at the European Renal Association’s 2023 Congress in Milan, Italy.

David Plappert, MD, and colleagues at Robert-Bosch-Hospital in Stuttgart, Germany, studied 74 patients with AAV admitted to their institution. They observed the vasculitis time course during the acute phase: 180 days after the initial diagnosis or relapse for each patient. At initial diagnosis, kidney disease was the most common clinical manifestation of AAV. It was present in 51 patients.

The most common AAV subtype was granulomatosis with polyangiitis (GPA; 48 patients), followed by microscopic polyangiitis (22 patients), and eosinophilic GPA (4 patients). The study population had a mean follow-up duration of 8 years. The mean duration of glucocorticoid treatment was 4.2 years, the investigators reported in a poster presentation. All patients received prednisolone; 73% of them also received methylprednisolone for induction therapy.

Overall, 14% of patients had diabetes prior to their AAV diagnosis and 20% had new-onset diabetes following AAV diagnosis.

The daily and accumulated glucocorticoid dose did not differ between patients with and without diabetes, although there was a significantly higher accumulated dose in patients who required insulin therapy for diabetes management compared with those on oral antidiabetic agents.

Further, 89% of patients received antihypertensive therapy. Of these, 38% had preexisting hypertension and 51% had new-onset hypertension. The accumulated dose of prednisolone within the first 180 days after a vasculitis event was not significantly higher for patients with documented hypertension, according to the investigators. The mean accumulated glucocorticoid dose after a vasculitis event, however, was significantly higher for patients who required escalation of antihypertensive therapy compared with those whose therapy was stable or deescalated.

With regard to hypercholesterolemia, the investigators observed no significant difference in accumulated glucocorticoid dose during the acute course between patients who took statins and those who did not.

The study provides additional evidence of treatment-related harms in AAV and supports alternative reduced-dose or even glucocorticoid-free treatment approaches, the investigators concluded. This study may be relevant for identifying risk groups for whom glucocorticoid-sparing treatments such as avacopan are essential to decrease treatment-related harms.

Reference

Plappert D, Schmid N, Schanz M, Latus J, Ketteler M. Glucocorticoid-related adverse effects in the treatment of ANCA-associated vasculitis. Presented at: ERA 2023, June 15-18, Milan, Italy. Abstract 4732.

This article originally appeared on Renal and Urology News