Findings of a global trial of plasma exchange and steroid dosing in autoimmune vasculitis (PEXIVAS) have recently been published in the New England Journal of Medicine. PEXIVAS, led by David Jayne (Medicine) and sponsored by CUHFT, was the first global vasculitis study, recruiting from 120 sites across Europe, North America, Japan and Australia/New Zealand, and at over 700 patients was the largest vasculitis trial performed to date.
Severe, anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV) is a rare disease of the immune system. There are two major problems that hinder the treatment of AAV. The first is a lack of treatment to bring the disease under control quickly before it causes major organ damage. The second is a high degree of treatment related toxicity.
PEXIVAS looked to examine these issues in patients with severe AAV. The research found that the use of plasma exchange did not reduce the incidence of death or end-stage kidney disease. A reduced-dose regimen of glucocorticoids was non-inferior to a standard-dose regimen with respect to death or end-stage kidney disease. Furthermore, reduced-dose glucocorticoids was associated with fewer serious infections after one year of treatment. These findings will impact on the treatment of these kidney and life threatening disorders.