Reduced-Dose vs High-Dose Glucocorticoids Added to Rituximab and Remission Induction in ANCA-Associated Vasculitis

To the Editor We have some concerns about the recent study about rituximab and reduced-dose glucocorticoids vs high-dose glucocorticoids in antineutrophil cytoplasm antibody (ANCA) –associated vasculitis. In addition to the limitations of being an open-label, single-country study recruiting only new patients and having a wide noninferiority margin of −0 percentage points, the patients enrolled in this study were older (more likely to have adverse effects with high-dose glu cocorticoids), had a higher proportion of myeloperoxidase (MPO) positivity (which is associated with lower chance of relapse), had a higher mean estimated glomerular filtration rate (eGFR), and had no pulse glucocorticoid therapy compared with the studies mentioned by the authors. The mean eGFR in t he reduced-dose glucocorticoid group was 55 mL/min/1.73 m2. Therefore, most of these patients had normal to mildly abnormal kidney function, considering their age. Furthermore, because most patients had microscopic polyangiitis/MPO-ANCA positivity, which is less likely to relapse than those with gra nulomatosis with polyangiitis/proteinase 3 (PR3)–ANCA positivity, they were likely to remain in remission with reduced-dose glucocorticoids. It would be helpful to know if patients with PR3 positivity had the same response rate as MPO-positive patients in the study. Also, we would be interested to learn how the authors chose the treatment regimen, given that the cumulative glucocorticoid dose in the high-dose g...
Source: JAMA - Category: General Medicine Source Type: research