Early Disease Management in ANCA-Associated Vasculitis Indicative of Long-term Outcomes

Disease status as early as three and six months may predict long-term outcomes in antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) patients, a study has found. 

Researchers analyzed the CYCAZAREM, NORAM, MEPEX & CYCLOPS trials and long-term registry data. They evaluated patients at baseline, three months, and six months for mortality and end-stage renal failure (ESRF) risks. Six-month outcomes were sustained remission (remission by three months, 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). 

Analysis of disease activity in 354 patients with ANCA associated vasculitis (AAV) enrolled in 4 trials shows 13% with ESRD and 19% died. Disease activity at 3 & 6 mos predicted later ESRD or death https://t.co/NZu1kJuFF2

— Dr. John Cush (@RheumNow) November 14, 2018

A total of 354 patients were followed for 5.7 years, of which 46 (13%) developed ESRF, 66 (18.6%) died, and 89 (25.1%) suffered either death or ESRF. At six months, late remission (hazard ratio [HR] = 2.94 (1.1‐7.85), p = 0.031), relapsing disease (HR = 8.21 (2.73‐24.65), p = 0.001), and refractory disease (HR = 4.89 (1.96‐12.18), p = 0.001) all were associated with significantly increased odds of the endpoints of death or ESRF. Researchers observed similar results when looking specifically at odds of death and ESRF. Age (HR = 1.02 (1‐1.05) and estimated glomerular filtration rate (HR = 0.94 (0.92‐0.95), p = 0.001) were also correlated with death and ESRF. 

“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,” the researchers wrote. “These results need to be validated in a larger dataset.” 

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Source: Arthritis & Rheumatology