{
  "abstract": "Objective To examine the role of low-dose glucocorticoids (GCs) in major relapse, hospitalisation and damage accumulation risk during maintenance therapy in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs).Methods Retrospective cohort study of newly diagnosed patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) followed in three tertiary referral centres. We recorded relapses (Birmingham Vasculitis Activity Score increase >0), increases in Vasculitis Damage Index (VDI) and hospitalisations. We used time-varying and mixed-effects Cox models to examine the effect of GCs on the risk of major relapses, VDI accumulation and hospitalisations. Sensitivity analysis was also conducted to address potential confounding.Results 171 patients (GPA: 107, MPA: 64, median age: 61 years) were included with a median follow-up of 88.2 months (803.4 patient years (PY)). We recorded 65 major relapses (8.1/100 PY) in 48 patients (28%), 65 events of new damage (8.1/100 PY) and 132 hospitalisations (16.4/100 PY). By multivariable analysis, rituximab use was associated with a lower risk (HR=0.21, 95% CI 0.09 to 0.47, p=0.0001) while disease activity at diagnosis was associated with an increased risk (HR=1.17, 95% CI 1.03 to 1.33, p=0.013) of major relapses. Low-dose GCs were not associated with a reduced major relapse risk (HR=0.96, 95% CI 0.88 to 1.05, p=0.36) but they were associated with a risk of damage accumulation (HR=1.52, 95% CI 1.19 to 1.93, p=0.0007) and hospitalisations (HR=1.24, 95% CI 1.06 to 1.45, p=0.006).Conclusion Higher GC exposure during maintenance therapy was not significantly associated with a lower major relapse risk whereas it was associated with damage accrual and hospitalisation. These findings may support decision making regarding long-term GC use in patients with GPA/MPA.",
  "authors": [
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece",
        "Biostatistics and Health Data Science, Interdisciplinary Graduate Program National and Kapodistrian University of Athens, School of Medicine and Mathematics, Athens, Greece"
      ],
      "name": "Katerina Chavatza"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Chrysoula G Gialouri"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Konstantinos Drougkas"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Christos Koutsianas"
    },
    {
      "affiliations": [
        "Nephrology Department, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Aglaia Chalkia"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Noemin Kapsala"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Sofia Flouda"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Spyridon Katechis"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Dimitrios Tseronis"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Aggelos Banos"
    },
    {
      "affiliations": [
        "Rheumatology Clinic 'KAT' Hospital, Athens, Greece"
      ],
      "name": "Pelagia Katsimbri"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Konstantinos Thomas"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Christina Tsalapaki"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Antonis Fanouriakis"
    },
    {
      "affiliations": [
        "Nephrology Department, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Dimitrios Petras"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"
      ],
      "name": "Dimitrios T Boumpas"
    },
    {
      "affiliations": [
        "Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"
      ],
      "name": "Dimitrios Vassilopoulos"
    }
  ],
  "title": "No benefit of adding glucocorticoids to maintenance treatment in reducing the risk of major relapses in ANCA-associated vasculitis: real life data from a longitudinal cohort study",
  "uid": "1c69cd2d-0cdc-5ffd-8563-98ab0c5591a2"
}