重度の ANCA 関連血管炎に対する血漿交換とグルココルチコイド Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis

Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. The plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS) study is a currently enrolling study aiming to answer some of the outstanding questions relating to the use of this treatment in ANCA-associated vasculitis.This article aims to summarize available data on the use of plasma exchange in treating antineutrophil antibody (ANCA)-associated vasculitis. Part of

Among patients with severe ANCA-associated vasculitis, the use of plasma exchange did not reduce the incidence of death or ESKD. Proc Eur Dial Transpl Assoc 18:493–502Mauri JM, Gonzalez MT, Poveda R, Seron D, Torras J, Andujar J, Andres E, Alsina J (1985) Therapeutic plasma exchange in the treatment of rapidly progressive glomerulonephritis. The PEXIVAS study is a large, multinational, randomized study recruiting patients with severe vasculitis (documented renal involvement or pulmonary hemorrhage) in Europe, USA, Canada, Japan, Australia, and New Zealand [There has been some discussion over inclusion criteria for the study. Transfusion 50:471–477Higgins R, Lowe D, Hathaway M, Lam FT, Kashi H, Tan LC, Imray C, Fletcher S, Chen K, Krishnan N, Hamer R, Zehnder D, Briggs D (2010) Double filtration plasmapheresis in antibody-incompatible kidney transplantation. published an interesting study of 32 patients recruited between 1991 and 1995 and randomized in a two-by-two factorial design to either plasma exchange or control and in a second randomization to the use of cyclosporin at 3 months as compared with continuing CPA for a further 9 months [The results of these studies are combined in our Cochrane Systematic Review [Plasma exchange significantly reduced the risk of ESKD at 3 months [2 studies; relative risk (RR) 0.43; 95 % confidence interval (CI) 0.23–0.78); Effect of plasma exchange on the requirement for dialysis over timeWalsh et al. Jayne2 on behalf of the European Vasculitis Study Group (EUVAS) reported on 22 patients randomized to plasma exchange or control [In 1988, Glockner et al. There were no significant differences in serious adverse events across treatment groups. Kidney Int 40:757–763Cole E, Cattran D, Magil A, Greenwood C, Churchill D, Sutton D, Clark W, Morrin P, Posen G, Bernstein K (1992) A prospective randomized trial of plasma exchange as additive therapy in idiopathic crescentic glomerulonephritis. 382 No. Extended Description. Lancet 309:264Becker GJ, d’ Apice AJ, Walker RG, Kincaid-Smith P (1977) Plasmapheresis in the treatment of glomerulonephritis.

Register for 3 FREE subscriber-only articles each month. Recently Published Articles Membrane plasma separator. JAMA 244:2423–2426Sueoka A (1997) Present status of apheresis technologies: Part 1. Plasma Ther Transf Technol 6:587–591Glöckner WM, Sieberth HG, Wichmann HE, Backes E, Bambauer R, Boesken WH, Bohle A, Daul A, Graben N, Keller F (1988) Plasma exchange and immunosuppression in rapidly progressive glomerulonephritis: a controlled, multi-center study.

Death from any cause or end-stage kidney disease occurred in 28.4% of patients (100 of 352) assigned to receive plasma exchange and 31.0% of patients (109 of 352) assigned to receive no plasma exchange (P=0.27) and in 25.5% of patients (83 of 325) assigned to receive standard-dose glucocorticoids and 27.9% of patients (92 of 330) assigned to receive reduced-dose glucocorticoids (noninferiority margin, 11 percentage points). 1. Eur J Pediatr 166:145–151Rifle G, Chalopin JM, Zech P, Deteix P, Ducret F, Vialtel P, Cordonnier D (1981) Treatment of idiopathic acute crescentic glomerulonephritis by immunodepression and plasma-exchanges.

Nephrol Dial Transplant 26:206–213Walters G, Willis NS, Craig JC (2008) Interventions for renal vasculitis in adults.

published a similar systematic review as the basis for establishing the PEXIVAS study [Current data support the use of plasma exchange in a highly restricted group of patients in order to reduce the incidence of ESKD.