Role of Plasma exchange in ANCA-associated vasculitis
Fernando Fervenza, MD (Mayo Clinic, Rochester, MN)
Dr. Fervenza isn’t a believer in plasma exchange (PLEX) for ANCA-associated vasculitis, and it showed in the presentation today (though he gave an admirable well-balanced look at the data). The data is sparse at best, with the most notable presentation being MEPEX. In this trial, GPA patients (known as Wegener patients back then) were given methylprednisolone 1 g x 3 days *or* PLEX for 7 sessions. The trial showed a significant improvement in the time to develop ESRD in those patients who received PLEX. In other words, those who received PLEX took longer to develop ESRD than those who just received high dose steroids.
Here’s the catch: the trial followed patients for about one year. If you look at subsequent analyses (and re-analyses of the MEPEX data), you note that after 12 months and for as far as 5 years, there is no difference in time to developing ESRD. So the benefit is “wiped away” one year after receiving PLEX.
We’re now waiting for more definitive data from the PEXIVAS trial. Conducted by Dr. Jayne and colleagues, a group of 500 patients will be randomized to either CYC or RTX, then further randomized to PLEX or no PLEX, and then randomized one more time to high-dose or low-dose steroids. The primary end-points will be time to ESRD and death. Dr. Fervenza did not have preliminary data to show us, so we’ll have to wait until NKF 2013 to learn of the results!
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