What is this review about?
Induction and maintenance therapy for renal vasculitis.
What are the findings?
Plasma exchange used as adjunctive treatment to immunosuppression reduced the risk of end‐stage renal failure at 3 (two studies; 147 participants; Relative Risk (RR) 0.43; 95% CI 0.23–0.7; I2 = 0%; Number Needed to Treat (NNT) = 5) and 12 months (six studies; 235 participants; RR 0.45; 95% CI 0.29–0.72; I2 = 0%; NNT = 5) (Fig. 1). Pulse cyclophosphamide is as effective as continuous cyclophosphamide in remission induction but leads to an increased risk of relapse (four studies; 235 participants; RR 1.79; 95% CI 1.11–2.87; I2 = 0%; Number Needed to Harm (NNH) = 5) (Fig. 2). Rituximab is as effective as cyclophosphamide for remission induction with a similar side effect profile. Mycophenolate is possibly more effective than cyclophosphamide for remission induction at 6 months (three studies; 217 participants; RR 1.17; 95% CI 1.02–1.35; I2 = 4%) but resulted in a shorter time to relapse compared with azathioprine when it was used as a maintenance agent (one study; 156 participants; RR 1.47; 95% CI 1.04–2.09). In maintenance therapy, azathioprine is equivalent to cyclophosphamide. Mycophenolate, methotrexate and leflunomide are all potential alternatives for maintenance.