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"They saved my Dad’s life and I figured out what to do with mine"

Story featured on Thursday February 13th in:

 

At 54, Tom Salisbury was a firefighter who developed joint pain and a cold that he couldn’t shake. When he began coughing up blood, his wife and daughters prepared for bad news. With the help of doctors at St. Joseph’s Healthcare Hamilton, Tom was diagnosed with a type of vasculitis, a rare auto-immune disease that causes inflammation of the blood vessels that can lead to hemorrhaging in the lungs and rapidly progressive kidney failure. Without treatment it is almost certainly fatal. Little did they know that having this illness would introduce them to a research study that potentially saved Tom’s life and altered the career path of his daughter.

Pictured: Maddie Salisbury, Tom Salisbury, and Dr. Michael Walsh

Tom was admitted to hospital the weekend he was diagnosed and was given a course of immunosuppressants, including prednisone steroids. Steroids help treat vasculitis by suppressing the immune system to reduce inflammation, but they also put patients at a higher risk of developing life-threatening infections. On Monday morning, Tom was introduced to Dr. Michael Walsh who asked him to be a part of an international research study to improve outcomes for patients with vasculitis. During Tom’s treatment at St. Joe’s, his daughter Maddie Salisbury was at his side as much as she could while studying kinesiology.

“Patients that participate in research studies are people first; they’re not guinea pigs,” says Maddie Salisbury, Tom’s 26-year-old daughter. “I was so captivated by the type of life-changing research going on at St. Joe’s, I jumped at the chance to work with Dr. Walsh on studies like the one that helped save my dad’s life.”

“Infection is the most common cause of death associated with this kind of vasculitis disease, with one in three patients ending up in the hospital with a serious infection within their first year of treatment,” says Dr. Michael Walsh, a nephrologist and researcher at St. Joseph’s Healthcare Hamilton and associate professor at McMaster University. “Our study found that lower doses of steroids are as effective as higher doses in controlling the disease, while at the same time significantly reducing the risk of serious infections for patients.”

Prior to Dr. Walsh’s study, there were very little guidelines for the amount of steroids to prescribe during vasculitis treatment. Tom Salisbury was fortunate not to develop a serious infection during his treatment, something more patients will be able to avoid because of the results of this study.

With these findings, clinicians around the world have already begun to revise their standards for steroid treatment of vasculitis, therefore reducing the risks of serious infections. Findings from this clinical trial, called PEXIVAS (Plasma Exchange and Glucocorticoids for Treatment of Anti-Neutrophil Cytoplasm Antibody [ANCA]-Associated Vasculitis) were published in the New England Journal of Medicine on February 13, 2020.

PEXIVAS was the largest clinical trial for ANCA-associated vasculitis, and the first to test two treatments at the same time. It involved 95 recruitment centres across 16 countries. Across all 95 centres, nearly 10 percent of the research participants were recruited from St. Joe's – a testament to the incredible effort by the study team of Dr. Michael Walsh, Dr. Nader Khalidi, and Andrea Mazzetti.

Funding for the study was provided by the Canadian Institutes of Health Research, the National Institute of Health Research (UK), the Food and Drug Administration (US), the National Health and Medical Research Council of Australia, Assistance Publique (France), and the Agency for Medical Research and Development (Japan).

St. Joseph’s Healthcare Hamilton, a proud member of St. Joseph’s Health System, is a teaching hospital affiliated with the world-renowned McMaster University.

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