Low-dose glucocorticoids in ANCA-associated vasculitis maintenance therapy did not reduce major flare risk but increased chronic damage and hospitalizations, a new study suggests.
Study Details
A study presented at the EULAR 2026 Congress in London examined the impact of low-dose glucocorticoid use during maintenance treatment for ANCA-associated vasculitis (AAV). The study included 171 patients from three referral centers in Greece, with a median follow-up of just over 7 years.
Key Findings
- During follow-up, there were 65 major flares in 48 patients (8.1 per 100 patient-years).
- Rituximab use was associated with a lower risk for major flares; disease activity at diagnosis was associated with an increased risk.
- Concomitant glucocorticoid use at less than 7.5 mg per day showed no protective effect against major flares but was associated with an increased risk for damage accumulation and hospitalizations.
Background
EULAR recommends a combination of glucocorticoids with either rituximab or cyclophosphamide for remission induction in life-threatening or organ-threatening AAV, followed by gradual tapering of glucocorticoids. The introduction of biologics such as rituximab as maintenance therapy has reduced flare rates, but the benefit of concomitant low-dose glucocorticoids was unclear.
Expert Commentary
"Low-dose glucocorticoid added to standard maintenance did not reduce the risk of major flares, but it was associated with an increased risk of chronic damage and hospitalisation. These findings support earlier and more aggressive glucocorticoid withdrawal following remission in people with AAV."
— Katerina Chavatza, presenting author
Additional Findings on Giant Cell Arteritis (GCA)
A poster by Omar Dhrif and colleagues proposed a first definition of difficult-to-treat GCA, based on an analysis of 546 patients from the French Large Vessel Vasculitis Study Group.
Proposed Definition
The proposed definition includes three elements:
- Treatment with at least one immunosuppressive agent without ability to withdraw after 24 months due to persisting disease activity
- Inability to taper glucocorticoid dosage below 5 mg/day due to persisting disease activity
- At least two relapses during follow-up
Cohort Characteristics
In the cohort, 9.7% of patients were classified as difficult-to-treat GCA, characterized by predominant large-vessel vasculitis involvement, higher female representation, and difficulty tapering glucocorticoids beyond 6 months.
The maintenance glucocorticoid dose at Month 24 was 8.8 mg/day in difficult-to-treat patients versus 2.68 mg/day in others. The dosage at 6 months predicted progression to difficult-to-treat GCA in females with large-vessel vasculitis.
Clinical Implications
The authors suggest that the definition may guide early introduction of a glucocorticoid-sparing agent when targets are not met at Month 6, and they call for external validation of the predictive model.