Early relapse may occur in some patients treated with the LoVAS reduced-dose glucocorticoid regimen in real-world practice, with relapse occurring in 3/5 LoVAS patients compared to 2/16 PEXIVAS patients.
Key Findings
Results
Relapse occurred more frequently in the LoVAS group than the PEXIVAS group in this small cohort.
Relapse occurred in 3/5 patients (60%) in the LoVAS group and 2/16 patients (12.5%) in the PEXIVAS group.
In the LoVAS group, relapses occurred on days 21, 52, and 128 after treatment initiation, indicating early relapse events.
Time-to-event outcomes were analyzed using Kaplan-Meier curves and log-rank tests but were interpreted as exploratory because of the small sample size and limited number of events.
The study included 21 total patients with newly diagnosed or relapsing MPA or GPA treated between March 2022 and September 2025.
Results
GC withdrawal was achieved in all LoVAS patients but only a minority of PEXIVAS patients.
GC was withdrawn in 5/5 patients (100%) in the LoVAS group and 5/16 patients (31.25%) in the PEXIVAS group.
This difference reflects the more aggressive tapering schedule inherent to the LoVAS regimen.
The higher rate of GC withdrawal in the LoVAS group is consistent with the design intent of the LoVAS protocol.
Results
Cumulative glucocorticoid exposure was substantially lower in the LoVAS group compared to the PEXIVAS group.
The median average daily prednisolone-equivalent dose was 3.06 mg/day in the LoVAS group versus 14.5 mg/day in the PEXIVAS group.
This finding confirms that the LoVAS regimen achieves its intended goal of reduced steroid exposure.
Lower GC exposure in the LoVAS group occurred alongside a higher relapse rate, suggesting a potential trade-off between GC reduction and disease control.
Results
Serious adverse events occurred in a majority of LoVAS patients and nearly half of PEXIVAS patients.
Serious adverse events occurred in 3/5 patients (60%) in the LoVAS group and 7/16 patients (43.75%) in the PEXIVAS group.
The study did not provide a detailed breakdown of the types of serious adverse events in the abstract.
These findings were interpreted descriptively given the small sample size and limited number of events.
Methods
The study population consisted of patients with microscopic polyangiitis or granulomatosis with polyangiitis classified into LoVAS or PEXIVAS groups based on adherence to assigned regimens.
Patients were included if they adhered to the assigned reduced-dose GC regimen for at least 14 days.
A total of 21 patients were included: LoVAS group n=5, PEXIVAS group n=16.
The study was a retrospective single-center cohort study of consecutive patients treated between March 2022 and September 2025.
Both newly diagnosed and relapsing cases were included.
Conclusions
The authors characterize these findings as hypothesis-generating regarding early relapse risk with the LoVAS regimen in real-world practice.
The authors explicitly state 'these findings should be interpreted as hypothesis-generating and suggest that early relapse may occur in some patients treated with the LoVAS regimen in real-world practice.'
The authors call for 'further studies with larger cohorts and appropriate adjustment for confounding factors.'
The small sample size (n=21) and limited number of events precluded formal statistical inference.
What This Means
This research suggests that a newer, lower-dose steroid treatment strategy called the LoVAS regimen for a group of inflammatory diseases known as ANCA-associated vasculitis (specifically microscopic polyangiitis and granulomatosis with polyangiitis) may carry a higher risk of early disease relapse compared to another reduced-dose approach called the PEXIVAS regimen. In this small real-world study of 21 patients at a single hospital in Japan, 3 out of 5 patients on the LoVAS regimen experienced a relapse — some very early, within just 3 weeks of starting treatment — while only 2 out of 16 patients on the PEXIVAS regimen relapsed. The LoVAS regimen did successfully reduce overall steroid exposure, with patients receiving an average of only about 3 mg of prednisolone per day compared to about 14.5 mg per day in the PEXIVAS group, and all LoVAS patients were eventually able to stop steroids entirely.
These findings point to a possible trade-off: the LoVAS regimen is very effective at minimizing steroid use, which can reduce steroid-related side effects, but it may leave some patients without enough anti-inflammatory protection to prevent their disease from coming back quickly. ANCA-associated vasculitis is a serious condition that can damage the kidneys, lungs, and other organs, so early relapse is a clinically important concern.
However, this research involves a very small number of patients (only 5 in the LoVAS group), is from a single center, and was not designed to make definitive comparisons between the two treatment approaches. The authors themselves emphasize that the results are hypothesis-generating only and call for larger studies with better controls for other factors that might influence outcomes. This research suggests that clinicians using the LoVAS regimen in everyday practice should be aware of the potential for early relapse and monitor patients closely, particularly in the first few months of treatment.
Nakamoto N, Yahata A, Oiwa H. (2026). Early relapse under the LoVAS reduced-dose glucocorticoid regimen in ANCA-associated vasculitis: a single-center retrospective observational study.. Rheumatology international. https://doi.org/10.1007/s00296-026-06188-z