Effect Of Plasma Exchange On Patients With ANCA Associated Vasculitis: A Meta-analysis

Objective:To systematically review the clinical efficacy and prognosis of plasma exchange combined hormones and / or immunosuppressants on patients with ANCA associated vasculitis renal damage.Methods:Date from randomized controlled trials and array research delivered before2019.Pub Med,Embase,Chinese Biomedicine Literature Database,China National Knowledge Internet,Wanfang Data and CQVIP Database were systematically searched and related articles on the ANCA associated vasculitis with renal damage were selected.Two individuals independently evaluated articles according the inclusion and exclusion criteria in a two stages.They conducted literature screening,data extraction and quality evaluation.A total of 939 patients were included,of whom 463 were treated with PLEX and 503 were treated without PLEX.So there were 463 cases of PLEX group and503 cases of control group.Meta-analysis was performed by use of Review Manager 5.3software.Results:Fourteen studies involving 6 Chinese and 8 English documents were eventually included.The funnel plot was symmetrically distributed.Meta-analysis results is as follows.In terms of improvement of renal function,the total creatinine reduction in the PE group was more significant,and the difference was statistically significant [SMD=-0.45,95% CI(-0.84,-0.07),P=0.03].Subgroup analysis showed that the PE group was significantly improved in the the short-term efficacy compared with the control group,and the difference was statistically significant.However,there was no significant difference between the two groups in the long-term efficacy,and the difference was not statistically significant.There was no significant decrease in urea nitrogen in the PE group,and the difference was not statistically significant [SMD=0.25,95% CI(-0.37,0.87),P=0.43].In terms of primary disease control,the BVAS score of PLEX group decreased more significantly,and the difference was statistically significant [MD=-1.51,95% CI(-2.38,-0.64),P=0.0006].The decrease of ANCA level in PLEX group was more obvious,the difference was statistically significant [MD=-25.87,95% CI(-38.73,-13.01),P<0.0001].For long-term follow-up outcomes,the risk of death or ESRD was lower in the PLEX group than in the control group,and the difference was statistically significant[OR=0.68,95% CI(0.54,0.85),P=0.0008].The frequency of free from dialysis in the PLEX group was higher than that in the control group,and the difference was statistically significant [OR=2.15,95% CI(1.33,3.48),P=0.002].The incidence of adverse reactions was no significant between PLEX group and the control group.The adverse reactions mainly included pulmonary infection,tuberculosis,herpes zoster,gastrointestinal symptoms and liver damage.The difference was not statistically significant [OR=0.64,95% CI(0.39,1.05),P=0.08].Conclusion:Plasma exchange combined hormones and / or immunosuppressants can effectively reduce serum creatinine value,serum ANCA level,BVAS,reduce the composite end point and all-cause mortality of end-stage renal disease,improve disease control rate,but during follow-up the incidence of adverse reactions was no difference in both groups.Given the limited data available,more large research are needed to confirm this.