What is the evidence for the use of plasmapheresis in antineutrophil cytoplasmic autoantibody associated vasculitis?
There is a beneficial role for plasmapheresis in patients with severe kidney involvement (creatinine >500 μmol/L or 5.7 mg/dL) and ANCA-associated vasculitis. In contrast to anti-GBM disease, the addition of plasmapheresis to treatments including cyclophosphamide, azathioprine, and steroids was associated with better kidney survival. In patients with both ANCA and anti-GBM associated disease, as well as in any patient with diffuse pulmonary alveolar hemorrhage, plasmapheresis is beneficial for recovery and reducing the risk of progression to dialysis. The use of plasmapheresis for less severe kidney disease remains unresolved, but the PEXIVAS (Plasma Exchange and Glucocorticoid Dosing in the Treatment of ANCA Vasculitis) study is currently under way, with the aim to detect the efficacy of plasma exchange (PE) in this population.