Reduced-dose glucocorticoid tapering regimen for ANCA-associated vasculitis

This table provides an example of a reduced-dose, oral glucocorticoid-tapering regimen for patients with new-onset or relapsing ANCA-associated vasculitis. This tapering strategy compared favorably to a higher-dose strategy in patients with severe GPA or MPA in the PEXIVAS trial. UpToDate authors also feel this dosing is reasonable for treatment of new-onset or relapsing EGPA. Depending on disease severity and manifestations, the taper can be initiated immediately or after a course of IV glucocorticoids. Glucocorticoid tapers should be monitored by clinicians and halted for evidence of relapse. Slower tapers may be required for those with a history of relapses during tapers. Although 5 mg was continued to week 52 in the PEXIVAS trial, UpToDate authors note that further reduction in glucocorticoid dose after week 22 is typically individualized based on patient factors and concomitant therapies. Please refer to UpToDate content on the treatment of GPA, MPA, and EGPA for additional information.