Glucocorticoids (GCs) have been the cornerstone of antineutrophil cytoplasmic antibody–associated vasculitis (AAV) therapy since their advent in the 1950s. There is considerable variation in their use, both with respect to dose and duration. Given considerable treatment-related morbidity and mortality, refining the role of GCs is becoming increasingly important. This article discusses the current role of GCs in various phases of AAV treatment, including remission induction, maintenance therapy, treatment of relapses, and the use of local GCs. It discusses current controversies relating to GC use as well as research efforts that seek to reduce GC toxicity in AAV.
Key points
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Glucocorticoids (GCs) are an important component of antineutrophil cytoplasmic antibody–associated vasculitis (AAV) treatment, in part because of their rapid onset of action.
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Intravenous GCs are important to consider in severe AAV, although the evidence base for their use is limited.
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There is considerable variation in the duration of GC therapy, ranging from less than 6 months to more than 24 months.
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Local GCs can be an important adjunctive treatment of sinonasal, ocular, and subglottic disease, but are generally not sufficient as monotherapy.
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Studies are currently underway examining the dose and duration of GC therapy in AAV as well as the effectiveness of GC-sparing therapies.
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