ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 896

The Steroid Tapering in ANCA Vasculitis Evaluation Study (STAVE) 2: A Systematic Review and Meta-Analysis

Jennifer Rodrigues1, David Collister1, Amy Archer2, Kim Cheema3, Paul Alexander4, Christian Pagnoux5, Lehana Thabane4, Peter A. Merkel6, David Jayne7 and Michael Walsh1, 1Nephrology, McMaster University, Hamilton, ON, Canada, 2Rheumatology, Northwestern University, Chicago, IL, 3Nephrology, University of Calgary, Calgary, AB, Canada, 4Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, 5Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 6Division of Rheumatology, University of Pennsylvania; Perelman School of Medicine, Philadelphia, PA, 7Vasculitis and Lupus Clinic, Department of Medicine, University of Cambridge, Cambridge, United Kingdom

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ANCA, glucocorticoids, meta-analysis, prednisolone, prednisone and vasculitis

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis I: Clinical Trials and Outcomes

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Relapses of ANCA-associated vasculitis (AAV) are associated with death, decreased renal function, and end-stage renal disease.  Whether longer-term treatment with glucocorticoids (GC) reduces the risk of relapse is unclear.  The objective of this study was to determine the association between dosages of GC and relapse in patients with AAV and update a previous meta-analysis with long-term follow-up and trials with rituximab.

Methods: MEDLINE, EMBASE, Cochrane Clinical Trials, and the Grey Literature were searched from January 1, 2008 until May 26, 2016 without language restriction for studies with patients with AAV.  Studies were included if duration of GC use was specified a priori and patients were followed for a minimum of 18 months.  Both randomized controlled trials (RCT) and prospective cohort studies were included.  Quality of evidence was assessed using modified Newcastle-Ottawa criteria.  Meta-analysis was completed using a random-effects model of DerSimonian and Laird.

Results: Twenty-four studies met inclusion criteria consisting of 2272 patients. Thirteen (54%) discontinued GC in less than one year.  All patients received additional non-GC immunotherapy for induction of remission and 3 studies (<10% of patients) included patients receiving only GC as maintenance therapy.  The pooled relapse rate was 14.3 per 100 patient years (95% CI 4.5, 24.0).  Relapse was more frequent when discontinuation of GC at any time was compared to long-term, low-dose GC (20.7 per 100 patient years, 95% CI 6.8,34.5 as compared to 8.0 per 100 patient years, 95% CI 5.7,21.7).  Multivariable linear meta-regression confirmed that long-term, low-dose GC was associated with lower relapse rates (b = -0.16, 95% CI -0.26,0.07, P = 0.001) and overall follow up time was associated with increased relapse rates (b = 0.003, 95% CI 0.001,0.006, P = 0.002).  Time to discontinuation of non-GC immunotherapy, time to GC discontinuation, study type, renal function, presence of relapsing disease at baseline, and immunotherapy that included oral cyclophosphamide did not demonstrate any significant association with relapse rates.

Conclusion: Long-term, low-dose GC is associated with decreased relapse rates in patients with AAV.  The clinical severity and consequences of the excess relapses are not well studied.  Characterization and reporting of adverse events limited analysis.  These data have implications for both clinical care and trial design.  RCTs are needed to determine optimal GC administration in patients with AAV. 

Figure Legend: Random effects meta-analysis of long-term, low dose GC as compared to GC discontinuation on relapse per patient year.  CYC = cyclophosphamide, MTX = methotrexate, IV = intravenous, PO = oral, MMF = mycophenolate mofetil, AZA = azathioprine, LEF = leflunomide, RTX = rituximab, PLEX = plasma exchange, C = continuation arm, WD = withdrawal arm.  

Figure1.ACR.jpg


Disclosure: J. Rodrigues, None; D. Collister, None; A. Archer, None; K. Cheema, None; P. Alexander, None; C. Pagnoux, None; L. Thabane, None; P. A. Merkel, Actelion Pharmaceuticals US, Bristol-Myers Squibb, CaridianBCT, Celgene, ChemoCentryx, Genentech/Roche, GlaxoSmithKline, Kypha, MedImmune/AZ, 2,American College of Rheumatology, European League Against Rheumatism, Hational Institutes of Health, US Food and Drug Administration, The Patient-Centered Outcomes Research Institute, The Vasulitis Foundation, 2,Actelion Pharmaceuticals US, Alexion, Boston Pharm, Bristol-Myers Squibb, ChemoCentryx, Genzyme/Sanofi, GlaxoSmithKline, Genentech/Roche, InflRx, PrincipioBio, Proteon, Seattle Genetics, 5; D. Jayne, None; M. Walsh, None.

To cite this abstract in AMA style:

Rodrigues J, Collister D, Archer A, Cheema K, Alexander P, Pagnoux C, Thabane L, Merkel PA, Jayne D, Walsh M. The Steroid Tapering in ANCA Vasculitis Evaluation Study (STAVE) 2: A Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-steroid-tapering-in-anca-vasculitis-evaluation-study-stave-2-a-systematic-review-and-meta-analysis/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-steroid-tapering-in-anca-vasculitis-evaluation-study-stave-2-a-systematic-review-and-meta-analysis/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology