Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function

McGregor, Julie Anne G.; Negrete-López, Roberto; Poulton, Caroline J.; Kidd, Jason; Katsanos, Suzanne L.; Goetz, Lindsey; Hu, Yichun; Nachman, Patrick H.; Falk, Ronald J.; Hogan, Susan L.

doi:10.1093/ndt/gfv045

Cited by 75 publications

(63 citation statements)

References 34 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similarly, among those with a secondary diagnosis of GPA who died during the study period, infection was also the most common principal diagnosis and there was no significant change in this observation over the study period. These observations suggest that infection is an important cause of death among patients with GPA, which has been suggested in a previous general population study(2) and a recent cohort study(12). Improvements in the management of infectious complications may be contributing to the observed improvements in GPA in-hospital survival; efforts to reduce infectious complications may prevent hospitalizations and are likely to further reduce mortality in GPA patients.…”

Section: Discussionsupporting

confidence: 77%

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Wallace

Miloslavsky

et al. 2017

Arthritis Care & Research

View full text Add to dashboard Cite

Background Granulomatosis with polyangiitis (GPA) is a type of ANCA-associated vasculitis associated with severe end-organ damage and treatment-related complications that often lead to hospitalization and death. Nationwide trends in hospitalizations and in-hospital mortality over the past two decades are unknown and were evaluated in this study. Methods Using the National Inpatient Sample (NIS), the largest all-payer inpatient database in the US, the trends in hospitalizations with a discharge diagnosis of GPA (formerly Wegener’s granulomatosis; ICD-9-CM: 446.4) between 1993 and 2011 were studied. Analyses were performed using hospital-level sampling weights to obtain US national estimates. Results From 1993 to 2011, the annual hospitalization rate for patients with a principal diagnosis of GPA increased by 24% from 5.1 to 6.3/1,000,000 US persons (P-for-trend<0.0001); however, their in-hospital deaths declined by 73% from 9.1% to 2.5% (P-for-trend<0.0001), resulting in a net 66% reduction of the annual in-hospital mortality rate. The median length of stay declined by 20% from 6.9 days in 1993 to 5.5 days in 2011 (P-for-trend=0.0002). Infection was the most common principal discharge diagnosis when GPA was a secondary diagnosis, including among those who died during hospitalization. Conclusion The findings from these nationally representative, contemporary, inpatient data indicate that in-hospital mortality of GPA has declined substantially over the past two decades while the overall hospitalization rate for GPA increased slightly. Infection remains a common principal hospitalization diagnosis among GPA patients, including hospitalizations resulting in mortality.

show abstract

Section: Discussionsupporting

confidence: 77%

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Wallace

Miloslavsky

et al. 2017

Arthritis Care & Research

View full text Add to dashboard Cite

show abstract

“…They comprise three categories: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) [1]. Despite advances in both induction and maintenance treatment with less toxic regimes, infections continue to contribute heavily to morbidity and mortality [2,3]. The majority of these infections tend to be pulmonary in origin and the severity of the infection have been linked to mortality in a number of previous studies [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Late-onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA-associated vasculitis

et al. 2018

View full text Add to dashboard Cite

Immunosuppression in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is complicated by increasing risk of infections including opportunistic infections like Pneumocystis jirovecii pneumonia (PJP). Available evidence on risk factors and indications for prophylaxis in AAV is derived from PJP occurring early in the course of AAV. In this retrospective study, we characterized the profile of PJP in patients with AAV. PJP cases were identified retrospectively based on positive polymerase chain reaction test from electronic record followed by confirmation from medical records over a 10-year period. AAV patients without PJP over the same period were used as control group. Sixteen PJP+AAV+ were identified; in 14 of them, we were able to confirm they received PJP prophylaxis during induction therapy, while in two cases, data were missing. The onset of the infection was after 6 months from AAV diagnosis in 80% of cases. Escalations in immunosuppression prior to PJP were observed in six cases within 3 months prior to PJP onset. Overall mortality was 12.5%. By univariate analysis, renal involvement at AAV diagnosis was associated with PJP. These results indicate that PJP is not limited to the first 6 months following AAV diagnosis. Late-onset infection can occur in context of augmented immunotherapy, particularly with concurrent lymphopenia. Other risk factors that can independently predict late-onset PJP remain to be identified.

show abstract

“…In addition, both disease relapse and the burden of prior immunosuppression are factors associated with adverse events including infection, disease damage and mortality. [12][13][14] Therefore, previous disease relapse is suboptimal as a biomarker to guide treatment decisions. A readily available objective measure such as ANCA testing overcomes the limitation of having to wait until patients declare themselves as relapsers, offering clinicians the opportunity to make rational treatment decisions early during the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on ANCA type

et al. 2015

View full text Add to dashboard Cite

Objective To evaluate whether the classification of ANCA-associated vasculitis (AAV) patients according to ANCA type (anti-proteinase 3 [PR3] or anti-myeloperoxidase [MPO] antibodies) predicts treatment response. Methods Treatment responses were assessed among patients enrolled in the Rituximab in ANCA-associated Vasculitis trial according to both AAV diagnosis (granulomatosis with polyangiitis [GPA]/microscopic polyangiitis [MPA]) and ANCA type (PR3-AAV/MPO-AAV). Complete remission (CR) was defined as disease activity score of 0 and successful completion of the prednisone taper. Results PR3-AAV patients treated with rituximab (RTX) achieved CR at 6 months more frequently than did those randomized to cyclophosphamide (CYC)/azathioprine (AZA) (65% versus 48%; P=0.04). The odds ratio (OR) for CR at 6 months among PR3-AAV patients treated with RTX as opposed to CYC/AZA was 2.11 (95%CI 1.04–4.30) in analyses adjusted for age, sex, and new-onset versus relapsing disease at baseline. PR3-AAV patients with relapsing disease achieved CR more often following RTX treatment at 6 months (OR3.57; 95%CI 1.43–8.93); 12 months (OR4.32; 95%CI 1.53–12.15); and 18 months (OR3.06; 95%CI 1.05–8.97). No association between treatment and CR was observed in the MPO-AAV patient subset or in groups divided according to AAV diagnosis. Conclusion PR3-AAV patients respond better to RTX than to CYC/AZA. An ANCA type-based classification may guide immunosuppression in AAV.

show abstract

Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function

Abstract: More infections increase the risk of a severe infection which increases risk of all-cause mortality. Respiratory and S. aureus infections are dominant. Targeted prophylactic therapy could decrease morbidity.

Cited by 75 publications

References 34 publications

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Nationwide Trends in Hospitalizations and In‐Hospital Mortality in Granulomatosis With Polyangiitis (Wegener's)

Late-onset Pneumocystis jirovecii pneumonia (PJP) in patients with ANCA-associated vasculitis

Clinical outcomes of treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on ANCA type

Contact Info

Product

Resources

About