PDF(Pubmed)
Abstract：
To summarise and update evidence to inform the 2022 update of the EULAR recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis (AAV).
A systematic literature review (SLR) was performed to identify current evidence regarding treatment of AAV. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented here is focused on the treatment of granulomatosis with polyangiitis and microscopic polyangiitis.
3517 articles were screened and 175 assessed by full-text review. Ninety articles were included in the final evidence synthesis. Cyclophosphamide and rituximab (RTX) show similar efficacy for remission induction (level of evidence (LoE) 1a) but RTX is more effective in relapsing disease (LoE 1b). Glucocorticoid (GC) protocols with faster tapering result in similar remission rates but lower rates of serious infections (LoE 1b). Avacopan can be used to rapidly taper and replace GC (LoE 1b). Data on plasma exchange are inconsistent depending on the analysed trial populations but meta-analyses based on randomised controlled trials demonstrate a reduction of the risk of end-stage kidney disease at 1 year but not during long-term follow-up (LoE 1a). Use of RTX for maintenance of remission is associated with lower relapse rates compared with azathioprine (AZA, LoE 1b). Prolonged maintenance treatment results in lower relapse rates for both, AZA (LoE 1b) and RTX (LoE 1b).
This SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.
A systematic literature review (SLR) was performed to identify current evidence regarding treatment of AAV. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented here is focused on the treatment of granulomatosis with polyangiitis and microscopic polyangiitis.
3517 articles were screened and 175 assessed by full-text review. Ninety articles were included in the final evidence synthesis. Cyclophosphamide and rituximab (RTX) show similar efficacy for remission induction (level of evidence (LoE) 1a) but RTX is more effective in relapsing disease (LoE 1b). Glucocorticoid (GC) protocols with faster tapering result in similar remission rates but lower rates of serious infections (LoE 1b). Avacopan can be used to rapidly taper and replace GC (LoE 1b). Data on plasma exchange are inconsistent depending on the analysed trial populations but meta-analyses based on randomised controlled trials demonstrate a reduction of the risk of end-stage kidney disease at 1 year but not during long-term follow-up (LoE 1a). Use of RTX for maintenance of remission is associated with lower relapse rates compared with azathioprine (AZA, LoE 1b). Prolonged maintenance treatment results in lower relapse rates for both, AZA (LoE 1b) and RTX (LoE 1b).
This SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.
摘要：
目的：总结和更新证据，以告知2022年更新的EULAR抗中性粒细胞胞浆抗体相关血管炎（AAV）治疗建议。
方法：进行系统文献综述(SLR)以确定当前关于AAV治疗的证据。PubMed,EMBASE和Cochrane图书馆从2015年2月1日至2022年2月25日进行了搜索。此处提供的证据集中在肉芽肿合并多血管炎和显微镜下多血管炎的治疗上。
结果：共筛选了3517篇文章，通过全文回顾评估了175篇。最终的证据综合包括90篇文章。环磷酰胺和利妥昔单抗（RTX）对缓解诱导显示相似的功效（证据水平（LoE）1a），但RTX在复发性疾病中更有效（LoE1b）。糖皮质激素（GC）方案具有更快的逐渐减少导致类似的缓解率，但严重感染率较低（LoE1b）。Avacopan可用于快速锥化和替代GC（LoE1b）。根据所分析的试验人群，血浆置换的数据不一致，但基于随机对照试验的荟萃分析显示，在1年时，终末期肾病的风险降低，但在长期随访期间没有降低(LoE1a)。与硫唑嘌呤相比，使用RTX维持缓解与较低的复发率相关(AZA，LoE1b).延长维持治疗导致两者的复发率较低，AZA（LoE1b）和RTX（LoE1b）。
结论：本SLR提供了当前证据，以告知2022年更新的EULARAAV管理建议。
方法：进行系统文献综述(SLR)以确定当前关于AAV治疗的证据。PubMed,EMBASE和Cochrane图书馆从2015年2月1日至2022年2月25日进行了搜索。此处提供的证据集中在肉芽肿合并多血管炎和显微镜下多血管炎的治疗上。
结果：共筛选了3517篇文章，通过全文回顾评估了175篇。最终的证据综合包括90篇文章。环磷酰胺和利妥昔单抗（RTX）对缓解诱导显示相似的功效（证据水平（LoE）1a），但RTX在复发性疾病中更有效（LoE1b）。糖皮质激素（GC）方案具有更快的逐渐减少导致类似的缓解率，但严重感染率较低（LoE1b）。Avacopan可用于快速锥化和替代GC（LoE1b）。根据所分析的试验人群，血浆置换的数据不一致，但基于随机对照试验的荟萃分析显示，在1年时，终末期肾病的风险降低，但在长期随访期间没有降低(LoE1a)。与硫唑嘌呤相比，使用RTX维持缓解与较低的复发率相关(AZA，LoE1b).延长维持治疗导致两者的复发率较低，AZA（LoE1b）和RTX（LoE1b）。
结论：本SLR提供了当前证据，以告知2022年更新的EULARAAV管理建议。
