Περίληψη:
Background: Plasma exchange (PLEX) in addition to standard immunosuppressive treatment in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AVV) remains controversial. The aim of this study is to evaluate the effect of PLEX on AVV outcomes. Methods: Literature search was performed using Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov databases, and Google Scholar. The statistical meta-analysis and leave-one-out analysis were conducted using the Review Manager 5.3 and Open Meta-Analyst software, respectively. Results: Ten studies were included in the meta-analysis comprising 1235 patients; 633 received conventional treatment and 602 were treated with PLEX in conjunction with induction therapy. PLEX was not associated with lower rates of either mortality at 3 (RR: 0.79, 95% CI: 0.19–3.25) and 12 months (RR: 0.73, 95% CI: 0.40–1.34) or ESRD at 3 (RR: 0.30, 95% CI: 0.30–2.42) and 12 months (RR: 1.32, 95% CI: 0.53–3.25). Similarly, no differences were captured concerning disease relapses (RR: 0.92, 95% CI: 0.62–1.36), the incidence of infections (RR: 1.05, 95% CI: 0.63–1.76), and severe adverse effects (RR: 1.04, 95% CI: 0.59–1.81). Time-to-event analysis revealed lower incidence of ESRD (HR: 0.71, 95% CI: 0.55–0.92) among patients who received PLEX, while the overall mortality was similar (HR: 0.96, 95% CI: 0.72–1.29) between the two groups. Conclusion: The present meta-analysis does not support the wide use of PLEX for the management of AAV in routine clinical practice. Future well-designed randomized controlled trials focusing on specific disease-related manifestations are necessary to reach firm conclusions about the potential efficacy of PLEX.Key Points• PLEX is not widely recommended for the management of ANCA-associated vasculitis.• PLEX performance may reduce the overall incidence of ESRD in severe ANCA-associated vasculitis.• Well-designed randomized controlled trials focusing on specific disease-related manifestations are necessary to reach firm conclusions about the potential efficacy of PLEX on AAV-related outcome. © 2020, International League of Associations for Rheumatology (ILAR).
Συγγραφείς:
Bellos, I.
Michelakis, I.
Nikolopoulos, D.
Λέξεις-κλειδιά:
azathioprine; corticosteroid; cyclophosphamide; cyclosporine; methylprednisolone; mycophenolate mofetil; prednisolone; rituximab; immunosuppressive agent; neutrophil cytoplasmic antibody, adult; ANCA associated vasculitis; Article; clinical outcome; controlled study; end stage renal disease; female; human; incidence; infection; male; meta analysis; middle aged; mortality rate; multicenter study (topic); observational study; plasma exchange; priority journal; randomized controlled trial (topic); relapse; retrospective study; systematic review; ANCA associated vasculitis; plasma exchange; plasmapheresis, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Antineutrophil Cytoplasmic; Humans; Immunosuppressive Agents; Plasma Exchange; Plasmapheresis
