LoVAS: How low can we go with prednisone in ANCA vasculitis?

This is an exciting new trial for patients with newly diagnosed ANCA vasculitis (AAV). Particularly those with a positive MPO antibody.

140 Japanese patients with new onset AAV were enrolled. All patients were treated with Rituximab. Most of them had an MPO antibody and the average age was 73 years.

Half of the patients received a very low-dose prednisone course (starting at 0.5 mg/kg and reducing to 5 mg by week 7) and half received a high-dose prednisone course (starting at 1 mg/kg and reducing to ~35 mg by week 7). The low-dose group did just as well in terms of disease control at 6 months but had less infections, diabetes, insomnia and much less prednisone (cumulative dose 1300 mg vs 4200 mg). One would imagine they will also have less fractures in future years as weak bones (osteoporosis) are a common side effect from prednisone.

The rates of side effects for the high and low-dose prednisone groups are in the attached table.

I look forward to discussing this option with new MPO positive AAV patients and to future trials which will no doubt push the low dose prednisone envelope even further!