Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody–associated vasculitis: A meta-analysis
Article first published online: 16 MAR 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 8, pages 1166–1173, August 2010
How to Cite
Walsh, M., Merkel, P. A., Mahr, A. and Jayne, D. (2010), Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody–associated vasculitis: A meta-analysis. Arthritis Care Res, 62: 1166–1173. doi: 10.1002/acr.20176
- Issue published online: 3 AUG 2010
- Article first published online: 16 MAR 2010
- Manuscript Accepted: 25 FEB 2010
- Manuscript Received: 4 DEC 2008
- NIH. Grant Number: AR47785
- Vasculitis Clinical Research Consortium () through a grant from the NIH (National Center for Research Resources and National Institute of Arthritis and Musculoskeletal and Skin Diseases) [http://www.RareDiseasesNetwork.org/vcrc]. Grant Number: U54-RR019497
- Postdoctoral fellowship grants from the Kidney Research Scientist Core Education National Training program and the Alberta Heritage Foundation for Medical Research
- Mid-Career Development Award in Clinical Investigation (NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Number: K24-AR02224
Disease relapses are common for patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV). The role of low-dose glucocorticoids (GC) in relapse prevention is controversial. We undertook a systematic review and meta-analysis to determine if GC target doses influence relapses of AAV.
Medline, EMBase, and Cochrane databases were searched for observational studies and randomized controlled trials of treatment of AAV that included a predefined GC treatment plan. The association of GC target dose with the proportion of relapses in studies was assessed using meta-regression and multilevel generalized linear modeling.
Thirteen studies (983 patients) were identified for inclusion. There were no studies directly comparing GC regimens. We classified 288 patients as having a nonzero GC target dose by study end and 695 patients as having a zero GC target dose by study end. The pooled proportion of patients with a relapse was 36% (95% confidence interval [95% CI] 25–47%). GC regimen was the most significant variable explaining the variability between the proportions of patients with relapses. The proportion of patients with a relapse was 14% (95% CI 10–19%) in nonzero GC target dose studies and 43% (95% CI 33–52%) in zero GC target dose studies. Differences other than GC regimens exist between studies that complicate the comparability of trials and isolation of the variability in relapses due to GC target alone.
Studies with longer courses of GC in AAV are associated with fewer relapses. These results have implications for study design and outcome assessment in clinical trials of AAV.