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Suitability of reduced dose glucocorticoids therapy regimen for antibody-associated vasculitis patients with TB: a retrospective study

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Abstract

Intention

Immunosuppressive therapy is the major treatment approach for patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Due to impaired cellular immunological function and the use of glucocorticoids and immunosuppressants, AAV patients are predisposed to opportunistic infections, including tuberculosis (TB). This retrospective study aims to analyze the clinical characteristics of patients with AAV and TB and explore suitable glucocorticoid regimens for them. So as to provide a basis for future clinical guidelines and have important value for guiding clinical treatment.

Methods

This study retrospectively reviewed 58 AAV patients (18–80 years old) with TB admitted to Changsha Central Hospital Affiliated with the University of South China from 2016.1 to 2023.4 Patients were divided into standard-dose and reduced-dose glucocorticoid groups before retrospectively analyzing their medical records.

Results

A total of 58 AAV patients with TB were enrolled, with 15 dying throughout the monitoring period. Through analysis data, compared with the standard-dose group, the reduced group had less proteinuria and hematuria. In survival analysis, the reduced-dose glucocorticoid group had lower mortality than the standard-dose group (P = 0.03); however, no significant difference was noted in the use of immunoglobulin (P = 0.39), tuberculosis activity (P = 0.64), and age stratification (P = 0.40). The BVAS score before treatment and 6 months post-treatment suggest that the two regimens cause the same risk of ESKD (P > 0.05).

Conclusion

In conclusion, the reduced glucocorticoid dose group can achieve the same curative effect as the standard dose group and has less damage to the kidney in hematuria and proteinuria. Therefore, the reduced glucocorticoid dose treatment regimen may be more suitable for AAV patients with TB.

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Data availability

The data sets used and/or analyzed during the present study were availed by the corresponding author upon reasonable request.

Abbreviations

CHD:

Coronary heart disease

COPD:

Chronic Obistructive Pulmonary Disease

ESKD:

End Stage Kidney Disease

BAVS:

Birmingham vasculitis activity score

TB:

Tuberculosis

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Funding

This research was supported by the Hunan Provincial Natural Science Foundation Youth Foundation (Grant No. 2020JJ5611 and No. 2020JJ8044), Hunan Provincial Health Commission Foundation (Grant No. 202203052625), Changsha Central Hospital Subject of South China University (Grant No. YNKY202101), Scientific research Project of Education Department of Hunan Province (Grant No.22A0321), Hunan Provincial Science and Technology Department Project (Great No. kzd21074 and 2021SK53410).

Author information

Author notes

  1. Rui Wen and **gni **ao contributed equally to this work.

  2. Hebin **e and Jiao Qin contributed equally to this work.

Authors and Affiliations

  1. The Affiliated Changsha Central Hospital, Department of Nephrology, Hengyang Medical School, University of South China, Changsha, Hunan, 410004, China

    Rui Wen, **gni **ao, Qiong Yuan, Jiali Li, Qi Wang & Jiao Qin

  2. The Affiliated Changsha Central Hospital, Department of Emergency, Hengyang Medical School, University of South China, Changsha, Hunan, 410004, China

    Ning Ding

  3. Department of Nephrology, **angya Hospital, Central South University, Changsha, Hunan Province, China

    Yong Zhong

  4. Key Laboratory of Biological Nanotechnology of National Health Commission, **angya Hospital, Central South University, Changsha, Hunan, China

    Yong Zhong

  5. The Affiliated Changsha Central Hospital, Department of drug clinical trial institutions, Hengyang Medical School, University of South China, Changsha, Hunan, 410004, China

    Hebin **e

  6. Department of Nephrology, Changsha Central Hospital, University of South China, South Shaoshan Road No. 161, Changsha, China

    Jiao Qin

Authors
  1. Rui Wen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Rui Wen, **gni **ao, Qin Jiao, and Hebin **e. The first draft of the manuscript was written by Rui Wen and **gni **ao, and Ning Ding, Yong Zhong, Qiong Yuan, Jiali Li and Qi Wang commented on previous versions of the manuscript. All authors read and approved the final manuscript. Jiao Qin and Hebin **e contributed equally to this manuscript. Rui Wen and **gni **ao contributed equally to this manuscript.

Corresponding author

Correspondence to Jiao Qin.

Ethics declarations

Ethical approval

This study was approved by the Ethics Committee of Changsha Central Hospital, University of South China. Oral consent for this retrospective study was obtained from all patients or next of kin in the case of death.

Competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Moreover, Jiao Qin and Hebin **e contributed equally to this manuscript, Rui Wen and **gni **ao contributed equally to this manuscript.

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Wen, R., **ao, J., Ding, N. et al. Suitability of reduced dose glucocorticoids therapy regimen for antibody-associated vasculitis patients with TB: a retrospective study. Eur J Clin Microbiol Infect Dis 43, 1061–1072 (2024). https://doi.org/10.1007/s10096-024-04807-w

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