Effect of Disease Activity at Three and Six Months After Diagnosis on Long-Term Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.
European Vasculitis Society,
Arthritis & rheumatology (Hoboken, N.J.)
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Gopaluni, S., Flossmann, O., Little, M. A., O'Hara, P., Bekker, P., Jayne, D., & European Vasculitis Society,. (2019). Effect of Disease Activity at Three and Six Months After Diagnosis on Long-Term Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.. Arthritis & rheumatology (Hoboken, N.J.), 71 (5), 784-791. https://doi.org/10.1002/art.40776
Introduction: The treatment of ANCA associated vasculitis (AAV) aims to suppress disease activity and prevent subsequent disease flare. We explored the association of early disease control with long-term outcomes to validate early disease control as end-points for future clinical trials. Methods: Data from four inception trials (CYCAZAREM, NORAM, MEPEX & CYCLOPS) and subsequent long-term registry data were studied. Clinical parameters at baseline, three and six months were assessed to study the risk of death and end stage renal failure (ESRF). At six months, outcomes were defined as: sustained remission (remission by three, sustained to six months), late remission (remission after three and by six months), relapsing disease (remission by three months but relapse by six months), or refractory disease (no remission by six months). Results: Of 354 patients followed for a median of 5.7 years, 46(13%) developed ESRF, 66(18.6%) died and 89(25.1%) suffered either death or ESRF. At six months, age (HR=1.02(1-1.05), p=0.012*), eGFR (HR=0.94(0.92-0.95), p=0.001*), disease status at six months: late remission (HR=2.94(1.1-7.85), p=0.031*), relapsing disease (HR=8.21(2.73-24.65), p=0.001*), refractory disease (HR=4.89(1.96-12.18), p=0.001*), predicted the composite end-point of death or ESRF. Similar results were observed when these analyses were performed separately for death and ESRF. Conclusions: This study suggests that disease status at three and six months may predict the risk of long-term mortality and ESRF in AAV, and that these time points may be valid end-points for induction trials in AAV. These results need to be validated in a larger dataset.
European Vasculitis Society, Humans, Kidney Failure, Chronic, Recurrence, Immunosuppressive Agents, Glomerular Filtration Rate, Prognosis, Plasma Exchange, Remission Induction, Severity of Illness Index, Mortality, Proportional Hazards Models, Age Factors, Adult, Aged, Middle Aged, Female, Male, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Cambridge University Hospitals NHS Foundation Trust (CUH) (3819-1617-16)
External DOI: https://doi.org/10.1002/art.40776
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286888