Randomised Trial of Plasma Exchange or High Dose Methyl Prednisolone as Adjunctive Therapy for Severe Renal Vasculitis
Overview
- Phase
- Phase 2
- Intervention
- Plasma exchange
- Conditions
- Wegener's Granulomatosis
- Sponsor
- Cambridge University Hospitals NHS Foundation Trust
- Enrollment
- 150
- Locations
- 1
- Primary Endpoint
- Renal recovery
- Status
- Terminated
- Last Updated
- 14 years ago
Overview
Brief Summary
The purpose of this study is to test whether additional therapy with plasma exchange improves the chances of kidney recovery in severe kidney vasculitis.
Detailed Description
Primary systemic vasculitis associated with autoantibodies to neutrophil cytoplasmic antigens (ANCA), is the most frequent cause of rapidly progressive glomerulonephritis. Renal failure at presentation often progresses to end stage renal disease despite immunosuppressive therapy. We investigated whether the addition of plasma exchange was more effective than intravenous (IV) methyl prednisolone in the achievement of renal recovery for ANCA associated systemic vasculitis presenting with a serum creatinine above 500umol/l (5.8mg/dl). 137 patients with a new diagnosis of ANCA associated systemic vasculitis, serum creatinine above 500umol/l (5.8mg/dl) and a renal biopsy demonstrating a focal, necrotizing glomerulonephritis were randomized to receive seven plasma exchanges or IV methyl prednisolone 1000mg/day for three days. Both groups were treated with cyclophosphamide and oral prednisolone. The primary end-point was dialysis independence with a serum creatinine below 500umol/l (5.8mg/dl) at three months. Secondary end-points included renal and patient survival at 12 months and severe adverse event rates.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Diagnosis of Wegener's granulomatosis or microscopic polyangiitis, using criteria adapted by EUVAS from the disease definitions of the Chapel Hill consensus conference
- •Biopsy proven, pauci-immune, necrotising and/or crescentic glomerulonephritis, in the absence of other defined glomerulopathy
- •Severe renal impairment defined by: (i) oliguria (\<400ml/24hr), or (ii) intention to commence dialysis within 48 hours of admission, and (iii) creatinine \>500umol/l (5.8mg/dl).
Exclusion Criteria
- •Age under 18 or over 80 years
- •Inadequate contraception in women of child-bearing age
- •Pregnancy
- •Previous malignancy
- •Hepatitis B antigenaemia, anti-hepatitis C virus or anti-human immunodeficiency virus antibody
- •Diagnosis of Churg-Strauss syndrome, Henoch-Schönlein purpura, rheumatoid vasculitis, mixed essential cryoglobulinaemia or systemic lupus erythematosus
- •Circulating anti-GBM antibodies or linear IgG staining of the GBM on renal biopsy
- •Life-threatening non-renal manifestations of vasculitis, including alveolar hemorrhage requiring mechanical ventilation within 24 hours of admission
- •On dialysis for \> two weeks prior to entry
- •Creatinine \> 200umol/l (2.3mg/dl) one year or more before entry
Arms & Interventions
1
Plasma exchange x 7 over 14 days
Intervention: Plasma exchange
2
Methyl prednisolone 1g x 3
Intervention: Intravenous methyl prednisolone
2
Methyl prednisolone 1g x 3
Intervention: Methyl prednisolone
Outcomes
Primary Outcomes
Renal recovery
Time Frame: Three months
Secondary Outcomes
- Severe adverse events(12 months)
- End stage renal disease at 12 months(12 months)
- Serum creatinine at 12 months(12 months)