The value of pulse XXXX in ANCA-associated vasculitis: meta-analysis and critical review.

@entity1 @entity548 @entity454 @entity786 @entity177 @entity281 @entity204 @entity19417 @entity1210
BACKGROUND: The study aimed at studying efficacy and adverse effects of pulse @entity786 (pCyc) treatment and to compare it to continuous @entity786 (cCyc) for induction of remission in @entity19417 from data in the published literature. METHODS: A Medline search identified 14 studies, containing more than five @entity1 . From the 11 non-randomized studies, data on outcome following pCyc treatment were extracted. Results were given as fraction of the number of evaluable @entity1 . A meta-analysis was performed on the three prospective, randomized controlled trials to compare outcomes concerning remission, relapses, @entity281 , @entity1210 , @entity204 and @entity177 in @entity1 treated with pCyc as opposed to cCyc. RESULTS: The 11 non-randomized studies comprised 202 @entity1 receiving pCyc. Cyc pulses of 375-1000 mg/sqm/pulse were applied at weekly to monthly intervals with different concomitant prednisolone regimens and variable adjunctive therapy. Complete remission was achieved in 112/191, partial remission in 23/191 evaluable @entity1 . Relapses occurred in 68/135 @entity1 , 40/115 @entity1 were non-responders. @entity1210 , @entity281 , @entity548 , and @entity204 were rare. The meta-analysis, comprising 143 @entity1 , showed that pCyc compared with cCyc treatment was significantly less likely to fail to induce remission (OR 0.29; 95% CI 0.12-0.73) and had a significantly lower risk of @entity281 (OR 0.45; 95% CI 0.23-0.89) and @entity1210 (OR 0.36; 95% CI 0.17-0.78). Relapses occurred slightly, although not statistically significantly, more often under pCyc treatment (OR 1.79; 95% CI 0.85-3.75). There were no differences in @entity454 or @entity204 between the two regimens. CONCLUSIONS: The currently available, rather sparse data show that pCyc is less toxic than cCyc therapy and is an at least equally potent inductor of remission, but possibly at the expense of a higher relapse rate. The existing data do not give sufficient information on outcomes as time to remission and relapse, irreversible damage or quality of life without which a treatment regimen cannot satisfactorily be evaluated today. A large prospective randomized controlled trial is needed to address these issues and their relative importance.
