Granulomatosis with polyangiitis and microscopic polyangiitis are commonly grouped together as AAV, Dr. Michael Walsh of St. Joseph's Hospital in Hamilton, Canada, and colleagues explain in The BMJ.
"Although treatment with immunosuppression and glucocorticoids improve the outcomes of patients with AAV, they remain at high risk of death, end stage kidney disease (ESKD), and serious infections, particularly in the first year of treatment," they point out.
Since the 1980s, plasma exchange has been used to treat some patients with AAV based on "biological rationale and small clinical trials," the researchers note.
Plasma exchange removes circulating plasma constituents, including immunoglobulins such as ANCA, which may reduce damage incurred by AAV.
Recent publication of a large trial evaluating plasma exchange in patients with AAV necessitated an updated review, which included data from nine randomized controlled trials that evaluated the effects of plasma exchange in total of 1,060 patients with AAV, the authors note.
Their analysis suggests that plasma exchange, when added to standard therapies, significantly reduces the risk of ESRD at one year (relative risk, 0.62), regardless of baseline kidney function.
However, plasma exchange also increases the risk of serious infections (RR, 1.27), a previously unrecognized effect, they note.
This "important" finding may explain the lack of effect of plasma exchange on all-cause mortality "despite the large effect on ESKD," they note.
"This systematic review included substantially more data than our previous review and used more granular data than other systematic reviews. Accordingly, the estimates from this review are more refined than those of previous reviews," they write.
The paper provides "absolute risk reductions and increases for important outcomes that will help healthcare providers, patients, and family members engage in shared decision making," they add.
The study received no funding.
SOURCE: https://bit.ly/344K6j3 The BMJ, online February 25, 2022.
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