Thread by @NamrataYParikh

PEXIVAS - The groundbreaking results of this trial are finally out!! A quick recap of some of the landmark trials in vasculitis

⚫INDUCTION TRIALS
☑️ NORAM
☑️ CYCLOPS
☑️ RAVE
☑️ RITUXIVAS
☑️ MEPEX
☑️ MYCYC
☑️ CORTAGE

NORAM ⏩ Methotrexate 🆚 oral cyclophosphamide ⏩ Methotrexate not inferior but associated with shorter time to relapse

CYCLOPS ⏩ IV pulse cyclophosphamide 🆚 daily oral cyclophosphamide ⏩ IV pulse not inferior to oral but associated with more relapses

RITUXIVAS ⏩ 4 weekly doses of rituximab 375 mg/m2 ➕ 2 pulses of IV cyclophosphamide 🆚 only IV cyclophosphamide ⏩ Rituximab not inferior

RAVE ⏩ 4 weekly doses of rituximab 🆚 daily oral cyclophosphamide ⏩ Rituximab not inferior

MEPEX ⏩ plasma exchange ➕ oral cyclophosphamide 🆚 IV methyl prednisolone ➕ oral cyclophosphamide ⏩ plasma exchange associated with better renal survival

MYCYC ⏩ Mycophenolate mofetil 🆚 IV pulse cyclophosphamide ⏩ non-inferiority of MMF could NOT be proven

CORTAGE ⏩ Rapid glucocorticoid taper and low dose IV cyclophosphamide 🆚 standard dose cyclophosphamide ⏩ No difference in remission and relapse rates

⚫ MAINTENANCE TRIALS
☑️ CYCAZAREM
☑️ IMPROVE
☑️ WEGENT
☑️ LEM
☑️ WGET

CYCAZAREM ⏩ oral cyclophosphamide 🆚 oral azathioprine ⏩ No difference in relapse

IMPROVE ⏩ oral Mycophenolate mofetil 🆚 oral azathioprine ⏩ more relapses with Mycophenolate

WEGENT ⏩ methotrexate 🆚 azathioprine ⏩ No difference in relapses

LEM ⏩ leflunomide 🆚 methotrexate ⏩ More adverse events with leflunomide

WGET ⏩ Methotrexate ➕ cyclophosphamide ➕etanercept 🆚 placebo ⏩ increased risk of cancer with etanercept

Did I miss any?

⚫ Addendum

MAINRITSAN ⏩ Maintenance trial ⏩ Rituximab 🆚 Azathioprine ⏩ Rituximab was superior

RITAZAREM ⏩ Maintenance trial ⏩ Rituximab 🆚 Azathioprine ⏩ Results awaited