Steroids to suppress the information giving and then you get such a fuss for my to try and suppress so this was actually developed and we’re doing much to say now it’s one of the drug have changed of course rash gbn disease today the street very long you just need to treat for a few weeks and then you can stop the treatment we do have a new drug that would develop
In french tv and disease and there’s a new interesting the transplant literature will have seen data on this drug so this is a trip streptococcal pray scene which please i junkie and within minutes of inclusiveness pray see the oxygen under the blood gets back to zero that takes karate immediately to zero so has been used to desensitize patients brought to renal
Transplantation we’re using it in anti gbm aziz this just shows you what happens the entity knows they plan it right down and then after a week or two their cells and the concept of entropy embassies we want rapid action this is much more rapid just watch this but at least it is licensed and say there’s a little interest about combining or worried that it’s not
Strong enough what’s there i’m gonna say what about my family as far as steroids are concerned things really haven’t changed we give iv steroid and then we get all the steroids but i’ll show you the steroids lattissima is remarkably effective so this is data on 190 patients is relevant at trial they will have relapsing disease so this is slightly tougher to treat
Gpa mva and you can see very high remission rates is over 90% and in fact out of the hundred to your patients only about seven and advocacy failure the participant is a remarkably effective we don’t necessarily use it routinely to new patients and for our ppm said that all the patients we still release like the younger patient where the pressure of preserving
Typically we do two tricks tonight this car was reported last year and as a head to head of my family the majority to have renal disease that x 59 chevy normal other dealers that six months roughly similar response rates when we continued the trial and looked at relapse we saw a great excessive relapses in the tr3 group treated with mmm so when we sort of got a
Bit cold on using mycophenolate for pr3 npelra vasculitis just as a new cancer process i think it’s an option and there have been another couple of smaller randomised trials and pierre quebecers this is some non randomized data that is trying to get patients off steroids rapidly and over the years we’ve got to the conclusion which maybe you got to a long time ago
That steroids the main drivers of problems stare into the main drivers of infection and infections the main serious adverse event lease patients suffer from at this regimen combined for six in lab 2 times 1 gram the relative 600 gram positives and at least in small numbers sentiments observation we study and we use this sort of cocktail for the younger patients with
Severe up again because it’s like across my spare we’re giving this like a classified initially because we do think that’s doing something important in the kidney the rituximab comes in after a few weeks and supplies there what about plasma exchange well for at cbn disease were all gonna carry on using it agents around people to atlantica what about anca vasculitis
You just completed a big study which was but one of the first global studies for vasculitis looking at plasma exchange and this was our big innovation so as patients the gfl are less than 50 the average new grandma coming in so that’s people in 20 so there was severe renal disease the kick up here this is proportion of patients who are either dying or developing
Instead renal disease this is the kick up here’s the definition that stated it was these 12 weeks of dialysis and although there was a trend early on to a benefit that the plasma exchange group with follow-up that was completely lost and we see new for the group as a whole we’ve seen no sustained now the do some analyses were this trial that accommodates previous
Trials and we think that may be a role on some of the more severe patients but the take-home point from this is a custom exchange made by in a few months of dialysis but it captures up with you i think so we’re not going to recommend routine use of custom exchange another aspect of this particular trial was actually to test errors and as he made them as new trials
That we different staircases and we compared the sort of standard steroid days one thing the kilo coming down quite slowly over six months to what we call the rapidly reducing richmond when we reduced by half almost immediately such that we get about half the exposure to steroids so this is a non-inferiority move richmond’s ass good saving lives kidneys and we
Showed that say bracelet curves before really no difference so the non-inferiority hypothesis was accepted but more importantly with a fewer serious infections with the reduced steroid days so we now actually have a standardized expression which is if you’re wandering around with kilogram of data for a week then rapidly another question increasing these patients
Is how long should you treat poor and i’m vasculitis relapsing disorder increases it simply showed that if you gave two years based on steroids we saw more relapses when the drugs the trial started up two years out as opposed to continuing here department steroids and also the specific statistical differences people say this is a problem we have an alternative and
Research from ours now validated as a maintenance agents there was a rich booty to duction agent and the last year at least in us and in europe the license has been extended for maintenance agents based on this trial was six months ago this amount will compare today’s cochran and this completes contestant erosion so another bigger trial is home game and this well
I mentioned in the in the background basically described a products of c 5 c by b and that’s why you get the worries about but there are a couple of drugs that’ll be developed at target c friday in the struggle batman which is immoral specific c-5a receptor inhibitor and we did a phase 2 trial and in this trial we replaced steroids with the back of man or we had
An intermediate group of the low dose steroids and all the grafts have the same color code essentially the gray line is the high dose steroids the red line is zero steroids for the back of man and the blue line is low this dirty black man don’t be too much to jeer barça’s difference at baseline that this was what surprised us and this was born impression urea now
That capacity license typically you don’t see very rapid falls and question earrings comes down over a few months and this is what we saw in the control group but the ibaka pantry groups brought quickly this was mirrored by reductions fcp one said this tells the promise of the complete alternative to steroid for anka vasculitis the phase 3 trial which is ongoing
Is going to report in the next couple of months what about guidelines well the european guideline is a lack of us crisis for updates we couple of years ago three years ago about 2016 and some of what i said there were all in there’s guidelines kate i go as was referred to before the lunch break the flamenco stylings have been updated right now all have been proven
Updated and i think i’d be very critical to pay back again because i think particularly like their methodology to the america disease with standard for high-quality evidence but i think the guidelines will be learned practicing tuning our vasculitis there are going to be better than they were in 2012 a little bit not upsetting got paid like a tractor bits and the
Audience that broke me i say key messages are pg n is the potentially reversible cause of esrd and customizes the major stuff group we classify the questor opportunist ology always remember the secondary causes in terms of management we now have a staff establish original guidelines the roller physics lab is expanding and it’s one of surprising surprising things
To me that we took some has been around since 1996 and nobody else has put an antecedent when see its water immunity it’s really her clear on there are lots of ncd twenties in cancer but it’s still the only one we have an immunity i said a little bit about stereo dissing road are some exchanges diminishing and i think
Transcribed from video
David Jayne RPGN By Kenya Renal Association