ANCA-Associated Vasculitis: plasma exchange, glucocorticoids and avacopan - PWR (Nov 2024)

Dr. Michael Walsh of McMaster University presents his talk, “ANCA-Associated Vasculitis: plasma exchange, glucocorticoids and avacopan,” as part of UBC and BC Renal’s province-wide rounds. 0:04:35 – ANCA Associated Vasculitis Dr. Walsh starts by providing an overview of ANCA-associated vasculitis (AAV), noting that it can have many different manifestations. He says that, despite some advances in effective treatments, it still entails a high level of mortality and acute kidney failure. He discusses various guidelines on when to treat ANCA-associated vasculitis. 0:12:50 – Plasma exchange in AAV Dr. Walsh points to evidence suggesting that plasma exchange has some benefits, but may not be particularly effective at reducing risk of death or kidney disease. His own team explored this phenomenon in more detail, conducting a study of 700 participants. The results also show no major difference in mortality or kidney failure outcomes. In a much larger meta-analysis, Dr Walsh and his colleagues still didn’t see any benefit of plasma exchange in reducing overall mortality – however, evidence did show it reduced the need for dialysis after one year, although the effect diminishes after that. At the same time, there was an increased risk of infection after one year of plasma exchange. 0:28:15 – Predicting kidney failure risk He points to the ANCA Renal Risk Score (ARRS) as a tool to predict when patients may experience end-stage kidney disease, and when plasma exchange may be worth the increased risk of infection. Dr. Walsh notes his team has another paper pending, which highlights when plasma exchange can be used to reduce risk of kidney failure, but again emphasizes that the risk of infection remains a major issue. 0:38:15 – Plasma exchange guidelines Dr. Walsh discusses KDIGO guidelines for plasma exchange. He shares surveys of patients about shared decision-making, showing that patients valued the benefits and risks of plasma exchange very differently. He emphasizes the need to discuss risks and benefits of AAV treatment carefully with patients. 0:42:20 – Glucocorticoids Dr. Walsh highlight data showing that glucocorticoids regimens, including LoVAS and PEXIVAS. 0:45:08 – Avacopan Dr. Walsh highlights data on avacopan via the ADVOCATE trial, which shows the drug can help facilitate sustained remission, without the toxicity associated with glucocorticoids. He notes numerous cases when risk of glucocorticoid toxicity is particularly high and should be avoided. 0:52:30 – Summary and Q&A Dr. Walsh summarizes his talk, noting that plasma exchange does have a role in preventing dialysis, PLEXIVAS should be tapered off for most patients, and that avacopan is useful, but it has limitations should be considered carefully. He then takes questions from the audience. Click here to join our mailing list to receive the latest news and information from BC Renal: https://app.cyberimpact.com/clients/2...