From: Interventions for renal vasculitis in adults. A systematic review
Study ID | Treatment | Control | Study outcomes |
---|---|---|---|
Cole 1992 | PE: at least 10 PE treatments within 16 days of trial entry. One plasma volume with complete replacement using 5% albumin + crystalloid. Immunosuppression: as for control group | Immunosuppression IV MP 10 mg/kg/d for 3 days followed by prednisone 1.4 mg/kg/d for next 4 days and then tapered to 1 mg/kg/d over 2 weeks 0.35 mg/kg/d at 1 month and 0.25 mg/kg/d at 2 months. AZA 1.5-3.0 mg/kg/d with dose adjustment as necessary to ensure neutrophil count of 2.0 × 109/L or greater | 1. renal pathology 2. Patients on dialysis at randomisation - dialysis at 1, 3, 6, 12 months 3. Renal function in patients not on dialysis - 1, 3, 6, 12 months 4. Change in SCr 5. Adverse events (serious infections, gastrointestinal bleeding) 6. Mortality |
Jayne 2007 | Seven PE of 60 ml/kg in first 2 weeks after diagnosis Immunosuppression as for control group | Three pulses of 1000 mg IV MP followed by oral CPA and a tapering regimen of prednisolone. | 1. Mortality 2. Dialysis 3. Side effects 4. Serum creatinine at 12 months |
Glockner 1988 | Nine 50 ml/kg PE over 4 weeks replaced with 3-5% Albumin solution. Immunosuppression as for control group | CPA 3 mg/kg/d plus AZA 1 mg/kg/d for 1 week then AZA 2 mg/kg/d. 6-methyl prednisolone 1.5 mg/kg/d for 14 days reducing in 4 mg/d steps to maintenance 8 mg/d. | 1. Mortality at 6 months 2. Dialysis at 6 months 3. SCr at 4 weeks, 8 weeks and 6 months 4. Adverse events including serious infections, GI haemorrhage and anaphylaxis |
Mauri 1985 | PE alternate days for 6 treatments. Exchanges of at least 3.5 L replaced with 3.5% Albumin and 2 units FFP. Immunosuppression as for control group | CPA 2 mg/kg/d and Prednisolone 1 mg/kg/d. Doses reduced to half after 8 weeks. Prednisolone dose tapered progressively. CPA dose reduced to 0.5 mg/kg/d after 2 months then stopped after month 4. | 1. Mortality 2. Dialysis post treatment, at 3 months and 12 months after treatment 3. SCr after treatment and 6 months later |
Pusey 1991 | PE: 5 × 4 L exchanges of 5% albumin (plasma protein fraction) within first week. Two units of fresh frozen plasma were given at end of exchange. Total number of exchanges determined by clinical response. Immunosuppression as for control group | Induction therapy: 8 weeks of: 1. 60 mg/d prednisolone, reduce to 30 mg/d at week 3, taper slowly. 2. CPA 3 mg/kg/d or 2 mg/kg/d for those over 55 years 3. AZA 1 mg/kg/d or no AZA for those over 55 years Maintenance therapy: CPA stopped after 8 weeks in those with remission and AZA increased to 2-3 mg/kg/d, together with tapering doses of prednisolone" | 1. Improvement (fall in SCr > 25% or rise in CrCl > 25%; recovery of renal function in those initially on dialysis) 2. SCr 3. Dialysis 4. Death 5. Adverse event |
Rifle 1980 | PE. Five sessions during 5 successive days, then 3 sessions/week until 15 days after SCr reached a plateau. Treatment could not exceed 2 months. 1.5 plasma volumes exchanged. Immunosuppression as for control group | IV pulse MP (15 mg/kg/d for 3 days, tapered to 15 mg/d for 3 days, then 3 new pulses, then 15 mg/d for 7 weeks. CPA 2-3 mg/kg/d for 2 months. Calcium heparinate 9 days after renal biopsy for the duration of the study. | 1. Dialysis 2, 6 12, 24 months 2. CrCl at 2, 6 and 12 months. 3. Recovery (off dialysis) according to initial SCr level 4. Recovery (off dialysis) according to initial % of crescents 5. Death 6. Circulating immune complexes 7. Pathology changes 8. Adverse events (septicaemia) |