Grant: Project Grant

ANCA-associated vasculitis (AAV) is a serious condition causing inflammation of small blood vessels. This inflammation can be thought of as a "fire", which can spread quickly through the body and cause permanent damage. AAV often attacks the kidneys, which are needed for human health. Treating AAV is an emergency. Glucocorticoids, or steroids, are drugs that can quickly "put out" this fire of inflammation, but can also weaken the immune system, causing infections. For many years, doctors who treat vasculitis have given ultra-high-dose "pulse" steroids for several days intravenously (through a vein), to try to calm the inflammation more quickly and reduce kidney damage. However, we do not know whether more or higher "pulse" doses are better for treating the vasculitis, or if higher doses increase side effects. Because steroids are available everywhere, are cheap, and act quickly, but also cause major side effects, it is especially important to know how to use them in this serious health condition. Project goals and plan Our goal is to find out whether higher doses of "pulse" steroids lead to better outcomes for patients with AAV. To do this, we will analyze data from a large completed clinical trial called PEXIVAS. PEXIVAS included over 700 people with severe AAV from around the globe. In addition to the study treatments, all participants received some "pulse" steroids, but the participants' own doctors decided on the dose. We will examine the data from this trial to see if kidney function, vasculitis control, infection risk, and other side effects increase with increasing doses of "pulse" steroids. Impact: Although "pulse" steroids have been around for 50 years to treat vasculitis and other severe inflammatory conditions, we still do not know how to balance the benefits and potential harms of this treatment. Our results will provide doctors with much-needed answers to help them care for patients with AAV in the best possible way.