{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T17:01:04Z","timestamp":1782320464536,"version":"3.54.5"},"reference-count":26,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"unspecified","delay-in-days":84,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Special Account for Research Grants, National and Kapodistrian University of Athens, Athens, Greece and Hellenic Rheumatology Society (ERE-EPERE).","award":["DV#12085"],"award-info":[{"award-number":["DV#12085"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,6,11]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the role of low-dose glucocorticoids (GCs) in major relapse, hospitalisation and damage accumulation risk during maintenance therapy in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort study of newly diagnosed patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) followed in three tertiary referral centres. We recorded relapses (Birmingham Vasculitis Activity Score increase &gt;0), increases in Vasculitis Damage Index (VDI) and hospitalisations. We used time-varying and mixed-effects Cox models to examine the effect of GCs on the risk of major relapses, VDI accumulation and hospitalisations. Sensitivity analysis was also conducted to address potential confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>171 patients (GPA: 107, MPA: 64, median age: 61 years) were included with a median follow-up of 88.2 months (803.4 patient years (PY)). We recorded 65 major relapses (8.1\/100 PY) in 48 patients (28%), 65 events of new damage (8.1\/100 PY) and 132 hospitalisations (16.4\/100 PY). By multivariable analysis, rituximab use was associated with a lower risk (HR=0.21, 95% CI 0.09 to 0.47, p=0.0001) while disease activity at diagnosis was associated with an increased risk (HR=1.17, 95% CI 1.03 to 1.33, p=0.013) of major relapses. Low-dose GCs were not associated with a reduced major relapse risk (HR=0.96, 95% CI 0.88 to 1.05, p=0.36) but they were associated with a risk of damage accumulation (HR=1.52, 95% CI 1.19 to 1.93, p=0.0007) and hospitalisations (HR=1.24, 95% CI 1.06 to 1.45, p=0.006).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher GC exposure during maintenance therapy was not significantly associated with a lower major relapse risk whereas it was associated with damage accrual and hospitalisation. These findings may support decision making regarding long-term GC use in patients with GPA\/MPA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2026-006935","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T16:10:28Z","timestamp":1782317428000},"page":"e006935","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["No benefit of adding glucocorticoids to maintenance treatment in reducing the risk of major relapses in ANCA-associated vasculitis: real life data from a longitudinal cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1274-0909","authenticated-orcid":false,"given":"Katerina","family":"Chavatza","sequence":"first","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"},{"name":"Biostatistics and Health Data Science, Interdisciplinary Graduate Program National and Kapodistrian University of Athens, School of Medicine and Mathematics, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrysoula G","family":"Gialouri","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0143-6404","authenticated-orcid":false,"given":"Konstantinos","family":"Drougkas","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6621-6918","authenticated-orcid":false,"given":"Christos","family":"Koutsianas","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aglaia","family":"Chalkia","sequence":"additional","affiliation":[{"name":"Nephrology Department, General Hospital of Athens 'Hippokration', Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemin","family":"Kapsala","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5423-5847","authenticated-orcid":false,"given":"Sofia","family":"Flouda","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-5183","authenticated-orcid":false,"given":"Spyridon","family":"Katechis","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Tseronis","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5647-6505","authenticated-orcid":false,"given":"Aggelos","family":"Banos","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelagia","family":"Katsimbri","sequence":"additional","affiliation":[{"name":"Rheumatology Clinic 'KAT' Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-7776","authenticated-orcid":false,"given":"Konstantinos","family":"Thomas","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2532-0047","authenticated-orcid":false,"given":"Christina","family":"Tsalapaki","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-031X","authenticated-orcid":false,"given":"Antonis","family":"Fanouriakis","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Petras","sequence":"additional","affiliation":[{"name":"Nephrology Department, General Hospital of Athens 'Hippokration', Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios T","family":"Boumpas","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, 4th Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon General Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2288-3863","authenticated-orcid":false,"given":"Dimitrios","family":"Vassilopoulos","sequence":"additional","affiliation":[{"name":"Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, General Hospital of Athens 'Hippokration', Athens, 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ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial","volume":"82","author":"Smith","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"2026062409101735000_12.2.e006935.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.34583"},{"key":"2026062409101735000_12.2.e006935.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.20925","article-title":"Evaluation of rituximab for induction and maintenance therapy in patients 75 years and older with antineutrophil cytoplasmic antibody-associated vasculitis","volume":"5","author":"Thietart","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026062409101735000_12.2.e006935.12","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu452"},{"key":"2026062409101735000_12.2.e006935.13","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1093\/rheumatology\/keae409","article-title":"Relapses and serious adverse events during rituximab maintenance therapy in 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Risk of hospitalization with pneumonia in patients with giant cell arteritis and anti-neutrophil cytoplasmic antibody associated vasculitis. 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