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Low-Dose IV Methylprednisolone Safe, Effective for ANCA-Associated Vasculitis

Using a markedly reduced dose of intravenous (IV) methylprednisolone with a lower overall cumulative dose of glucocorticoids is safe and effective for managing ANCA-associated vasculitis (AAV), according to a recent study.

Previous research demonstrated that reduced oral glucocorticoid dosing is safe and effective, but data regarding the use of IV methylprednisolone are limited, investigators noted.

The finding is from a single-center retrospective cohort study in which patients newly diagnosed with AAV received either low-dose or high-dose glucocorticoids. The low-dose group received 250 mg IV methylprednisolone followed by a tapering course of 30 mg oral prednisolone daily; the high-dose group received 1.5 g IV methylprednisolone followed by a tapering course of 40-60 mg oral prednisolone daily. The primary outcomes were end-stage kidney disease (ESKD) and mortality.

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The investigators, led by Lauren Floyd, MBChB, of Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital in Preston, UK, included 65 patients in their final analysis: 31 in the low-dose and 34 in the high-dose group. The low-dose group had a higher proportion of patients with advanced renal impairment and histologic disease. The ESKD rate was similar between the groups at 6 and 12 months, Dr Floyd’s team reported in Kidney360. A higher proportion of patients in the high-dose than low-dose group died (26.5% vs 6.5%), but on multivariable analysis the difference was not significant. Further, the groups did not differ significantly in relapses and had comparable remission rates.

Both groups experienced adverse events, but the high-dose cohort had a higher number of severe infections, steroid-induced diabetes, and weight gain, according to the investigators.


Floyd L, Morris AD, Shetty A, et al. Low dose intravenous methylprednisolone in remission induction therapy for ANCA-associated vasculitis. Kidney 360. Published online September 5, 2023. doi:10.34067/KID.0000000000000222