title: [Therapy of ANCA-associated vasculitis with severe renal manifestation under routine conditions].
abstract: BACKGROUND
  In the MEPEX trial the poor prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with severe renal manifestation (AAVr) could be significantly improved in the first year by plasmapheresis. How and to what extent is this knowledge of AAVr therapy implemented into routine practice and what effectiveness and adverse events resulted?
  
  
  METHODS
  This was a retrospective cohort study in which all patients who received remission induction therapy for AAVr under routine clinical conditions (RCC) in this hospital from 2009 to 2014 after publication of the MEPEX trial (n = 22) were compared with those in the plasmapheresis arm of the MEPEX trial (n = 70). Endpoints were dialysis-dependent chronic kidney disease and mortality after 3 and 12 months and severe life-threatening adverse events during the first 12 months.
  
  
  RESULTS
  All patients with AAVr were treated by plasmapheresis under RCC. The two groups showed no differences with respect to the rate of dialysis dependency (after 3 months RCC 14 % versus MEPEX 16 %, P = 1.00 and after 12 months RCC 23 % versus MEPEX 14 %, P = 0.55) or mortality (after 3 months RCC 18 % versus MEPEX 16 %, P = 0.75 and after 12 months RCC 18 % versus MEPEX 27 %, P = 0.57). The rate of severe life-threatening adverse events was similar under RCC and under controlled study conditions (64 % versus 69 %, P = 0.87).
  
  
  CONCLUSIONS
  Under RCC there is a high quality of medical treatment for AAVr. All patients received plasmapheresis for remission induction with comparable effectiveness and safety compared to controlled study conditions.
authors.affiliation: Medizinische Klinik, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Stille
authors.affiliation: Klinik für internistische Rheumatologie, Rotes Kreuz Krankenhaus, Bremen, Deutschland.
authors.forename: J G
authors.initials: JG
authors.lastname: Kuipers
authors.affiliation: Medizinische Klinik, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Deutschland. herget-rosenthal.s@roteskreuzkrankenhaus.de.
authors.forename: S
authors.initials: S
authors.lastname: Herget-Rosenthal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000401:mortality* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000401:mortality* / Q000706:statistics & numerical data; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: Antineutrophil cytoplasmic antibody; Dialysis; Health services research; Plasmapheresis; Remission