Article Text

Original research
Comparative efficacy and safety of alternative glucocorticoids regimens in patients with ANCA-associated vasculitis: a systematic review
  1. Yingqi Xiao1,2,
  2. Gordon Guyatt1,3,
  3. Linan Zeng1,4,
  4. David RW Jayne5,
  5. Peter A Merkel6,
  6. Reed AC Siemieniuk1,3,
  7. Jared E Dookie7,
  8. Tayler A Buchan1,
  9. Muhammad Muneeb Ahmed8,
  10. Rachel J Couban9,
  11. Alfred Mahr10,
  12. Michael Walsh1,3,11
  1. 1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
  3. 3Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4Pharmacy Department/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
  5. 5Department of Medicine, University of Cambridge, Cambridge, UK
  6. 6Division of Rheumatology, Department of Medicine and Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  8. 8Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  9. 9DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
  10. 10Clinic for Rheumatology, Kantonsspital St Gallen, St Gallen, Switzerland
  11. 11Population Health Research Institute, Hamilton Health Sciences / McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Yingqi Xiao; xiaoyingqixyq{at}


Objective To compare the efficacy and safety of alternative glucocorticoids (GCs) regimens as induction therapy for patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis.

Design Systematic review of randomised controlled trials (RCTs).

Data sources Medline, Embase, and Cochrane Central Register of Controlled Trials up to 10 April 2020.

Study selection and review methods RCTs comparing two (or more) different dose regimens of GC in ANCA-associated vasculitis during induction of remission, regardless of other therapies. Pairs of reviewers independently screened records, extracted data and assessed risk of bias. Two reviewers rated certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results Of 3912 records identified, the full texts of two records met the eligibility criteria. Due to the heterogeneity of population and dose regimen of GCs between the two trials, we descriptively presented the two trials and did not combine the results using meta-analysis. Compared with the standard-dose regimen, the reduced-dose regimen of GC may reduce death risk difference (RD): from −1.7% to −2.1%, low certainty), while not increasing end-stage kidney disease (ESKD) (RD: from −1.5% to 0.4%, moderate certainty). The reduced-dose regimen probably has an important reduction in serious infections at 1 year (RD: from −12.8% to −5.9%, moderate certainty). Reduced-dose regimen of GCs probably has trivial or no effect in disease remission, relapse or health-related quality of life (moderate to high certainty).

Conclusions The reduced-dose regimen of GC may reduce death at the follow-up of 6 months to longer than 1 year and serious infections while not increasing ESKD.

PROSPERO registration number CRD42020179087.

  • haematology
  • oral medicine
  • clinical trials

Data availability statement

No data are available.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

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  • Twitter @muneebahmed1a, @lastwalsh

  • Contributors MW, AM, DJ, PAM and GG conceived the study idea. RJC performed the literature search. YX, JED, TAB and MMA performed the screening, data abstraction and risk of bias assessments. YX, LZ and MW performed the data analysis. YX, GG, LZ, RS, DJ, PAM and MW interpreted the data. YX, GG and LZ performed the certainty assessment. YX, GG, LZ and MW drafted the manuscript. All authors critically revised the manuscript. All authors approved the final version of the manuscript. YX and MW had full access to the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. YX and MW are the guarantors.

  • Funding This work was supported by China Scholarship Council grant number 201906240082.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.