Vasculitis treatment with fewer steroids

The insights from the PEXIVAS Trial, a 10-year study, shows treatment for ANCA-associated vasculitis can become much more patient-friendly.

A decade-spanning trial found that for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, two common methods of treatment actually do not have an impact on their long-term survival. The study, called PEXIVAS, was co-led by Peter A. Merkel, chief of Rheumatology in the Perelman School of Medicine, and was the largest ever conducted in vasculitis. It demonstrated that survival and progression to kidney failure (with the need for dialysis) for patients with ANCA-associated vasculitis remained virtually unchanged whether or not they underwent plasma exchange or if they took approximately half the typically prescribed dosage of oral glucocorticoids – which are commonly referred to as “steroids.” The study was published in the New England Journal of Medicine. 

microscopic view of the inside of a blood vessel
Researchers say these findings will likely lead to big changes in how this form of vasculitis is treated. That could benefit patients, particularly in reducing or eliminating plasma exchanges.

“This work should be the basis for a significant change in the standard of care for this type of vasculitis,” says Merkel, a professor of medicine at Penn and the principal investigator of the NIH-sponsored Vasculitis Clinical Research Consortium. “Adopting the changes in treatment we studied will greatly reduce our patients’ discomfort and their risk of developing several serious side effects from the current therapies.”

In ANCA-associated vasculitis, a person’s immune system attacks their small- and medium-sized blood vessels, resulting in inflammation and destruction. It is an organ- and life-threatening condition. The kidney is especially vulnerable, and the majority of patients with ANCA-associated vasculitis are at major risk of developing kidney failure.

Read more at Penn Medicine News.