Repository logo
 

Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data.

Accepted version
Peer-reviewed

No Thumbnail Available

Type

Article

Change log

Authors

de Joode, Anoek AE 
Sanders, Jan Stephan F 
Puéchal, Xavier 
Guillevin, Loic P 
Hiemstra, Thomas F 

Abstract

OBJECTIVE: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. METHODS: Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. RESULTS: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). CONCLUSION: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.

Description

Keywords

ANCA, EUVAS, FVSG, PR3, azathioprine, granulomatosis with polyangiitis, long-term follow-up, maintenance, vasculitis, Adult, Aged, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Antibodies, Antineutrophil Cytoplasmic, Azathioprine, Disease-Free Survival, Female, Follow-Up Studies, Granulomatosis with Polyangiitis, Humans, Immunosuppressive Agents, Kidney Diseases, Maintenance Chemotherapy, Male, Microscopic Polyangiitis, Middle Aged, Myeloblastin, Peroxidase, Recurrence, Time Factors, Young Adult

Journal Title

Rheumatology (Oxford)

Conference Name

Journal ISSN

1462-0324
1462-0332

Volume Title

56

Publisher

Oxford University Press (OUP)