ANCA-Associated Vasculitis — Refining Therapy with Plasma Exchange and Glucocorticoids
AbstractPlasma exchange has been a mainstay of induction therapy for patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis who have rapidly progressive glomerulonephritis or diffuse alveolar hemorrhage.1-3 Clinical data, in vitro data, and data from studies in animals have shown that ANCAs are pathogenic.4 Plasma exchange rapidly depletes pathogenic ANCAs and theoretically should diminish vascular injury and end-organ damage and hasten resolution of disease. In this issue of the Journal, Walsh et al. report the results of the PEXIVAS trial, a very large randomized clinical trial involving patients with ANCA-associated vasculitis (704 patients with a median follow-up of 2.9 years).5 The . . .