Comparison of the factors associated with the short-term prognosis between elderly and non-elderly patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: a retrospective observational study

Harada, Makoto; Yamaguchi, Akinori; Sonoda, Kosuke; Yamada, Yosuke; Aomura, Daiki; Kamimura, Yutaka; Hashimoto, Koji; Ichikawa, Takanori; Kobayashi, Mamoru; Kamijo, Yuji

doi:10.55563/clinexprheumatol/3qb95d

Cited by 4 publications

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“…Older age, diabetes, impaired renal function, lymphopenia, immunosuppressive therapy and a high cumulative dose of steroids were reported to be independent risk factors for infection in previous studies 4 6–14 18 37 38. Consistent with these findings, our results revealed that patients with infection were older, had more comorbidities, had a higher BVAS at the time of diagnosis, had more severe renal damage and received a higher dose of prednisone.…”

Section: Discussionsupporting

confidence: 91%

“…or cyclophosphamide (CYC)), have been identified as risk factors for infection in patients with AAV. [5][6][7][8][9][10][11][12][13][14][15] These factors are intertwined, which places clinicians in a therapeutic dilemma. A better understanding of infection-related factors helps to balance the benefits and risks associated with treatment.…”

Section: What This Study Addsmentioning

confidence: 99%

“…In observational studies, approximately 20%–60% of patients with ANCAs had infection episodes during treatment 2–6. According to previous literature, several features, such as older age, more comorbidities, disease severity, renal deficiency at baseline, pulmonary involvement or intensity of therapy (cumulative dose of steroids or cyclophosphamide (CYC)), have been identified as risk factors for infection in patients with AAV 5–15. These factors are intertwined, which places clinicians in a therapeutic dilemma.…”

Section: Introductionmentioning

confidence: 99%

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Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Chen

Jiang

et al. 2022

RMD Open

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ObjectivesThis study aimed to explore clinical features of early infection in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and to identify the association between the infection profile of patients with AAV during the first 3 months and 1-year survival.MethodsA total of 415 newly diagnosed patients with AAV in the Department of Nephrology at Shanghai Ruijin Hospital from 2000 to 2018 were included. Four Cox regression models were used to analyse the association based on demographics, comorbidities, laboratory baseline index and therapy parameter. Infection screening was carried out monthly during the first 3 months after diagnosis.ResultsIn all, 377 episodes of infection were identified among 220 patients during the first 3 months. The overall survival after 1 year was 73.0%. Respiratory infection (210 episodes/164 persons) accounted for more than half of infections. Infection was independently associated with 1-year mortality (adjusted HR 2.32, 95% CI 1.27 to 4.23, p=0.006) after adjustment. Respiratory infection (adjusted HR 4.36, 95% CI 2.86 to 8.06, p<0.001), Gram-negative bacterial infection (adjusted HR 1.71, 95% CI 1.01 to 2.91, p=0.047) and fungal infection (adjusted HR 1.77, 95% CI 1.07 to 2.94, p=0.026) was identified as a risk factor for 1-year mortality. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis (adjusted HR 0.55, 95% CI 0.31 to 0.97, p=0.040) was protective for 1-year mortality.ConclusionsInfections, particularly respiratory infections, are a common and important class of complication in patients with AAV and are associated with early mortality. TMP-SMX prophylaxis might be necessary to improve short-term outcome. More consideration of infectious risk and regular infection screening should be given.

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Section: Discussionsupporting

confidence: 91%

Section: What This Study Addsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Chen

Jiang

et al. 2022

RMD Open

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“…Unsere Ergebnisse bestätigen damit andere Studien, welche v. a. die Dauer der Glukokortikoidtherapie sowie die Entwicklung der GFR als Risikofaktoren für infektiöse Komplikationen identifizieren konnten [14][15][16]. Dies ist insofern interessant, da die Dauer der Glukokortikoidtherapie in unserer Analyse und in anderen Studien keinen signifikanten Einfluss auf Remissi-onserhalt, Rezidive und die Entwicklung einer terminalen Niereninsuffizienz hatte [17].…”

Section: Diskussionunclassified

Therapieansprechen und Komplikationen von älteren Patienten mit ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden

et al. 2022

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Zusammenfassung Hintergrund Von ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden (AAV) sind v. a. Menschen höheren Alters betroffen, ohne dass adaptierte Therapiekonzepte für diese Patienten existieren. Ziel der Studie Ziel der Studie war es, Unterschiede in Verlauf und Outcome von Patienten mit AAV hinsichtlich des Alters zu analysieren. Material und Methoden 62 Patienten wurden auf Therapieansprechen, 53 (85 %) davon konnten hinsichtlich unerwünschter Nebenwirkungen (AE und SAE), analysiert werden. Es wurden ältere (> 65 J.) mit jüngeren (< 65 J.) Patienten verglichen. Das Therapieansprechen wurde nach 6 Monaten, Komplikationen wurden über 18 Monaten beurteilt. Ergebnisse Das Therapieansprechen war in beiden Altersgruppen nicht unterschiedlich. In der multiplen logistischen Regression waren die pulmonale Beteiligung (OR = 6,9, KI = 1,7–27,8; p < 0,01) und die ΔGFR [ml/min] (OR = 0,93, KI = 0,89–0,97; p < 0,01) Prädiktoren für SAE. 14 Patienten hatten mehr als eine SAE; auch hier war eine pulmonale Manifestation bei Diagnose (28,2 % vs. 78,6 %, p < 0,01) Risikofaktor. Ältere Patienten (78,6 % vs. 43,6 %, p = 0,025) waren häufiger betroffen. Patienten mit mehreren SAE bekamen länger Glukokortikoiddosen über 5 mg/Tag (171 ± 65 Tage vs. 120 ± 70 Tage, p = 0,03). Diskussion Hinsichtlich des Therapieansprechens wurden keine Unterschiede zwischen älteren und jüngeren Patienten gefunden. Bei älteren Patienten traten häufiger mehrere SAE auf. Es bestand eine Korrelation zwischen pulmonaler Manifestation und Dauer einer Glukokortikoidgabe mit einem komplizierten Verlauf. Die häufigsten SAE waren Infektionen, welche einer stationären Aufnahme bedurften. Schlussfolgerung Die Therapie für ältere Patienten sollte individualisiert werden, mit dem Ziel einer raschen Reduktion von Glukokortikoiden. Ein besonderes Monitoring ist für ältere Patienten v. a. mit pulmonaler Manifestation bei Krankheitsbeginn angezeigt.

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Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): Part 2 - Treatment of eosinophilic granulomatosis with polyangiitis and diagnosis and general management of AAV

Sánchez‐Álamo

Schirmer²,

Hellmich³

et al. 2023

RMD Open

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ObjectiveTo summarise and update evidence to inform the 2022 update of the European Alliance of Associations of Rheumatology (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).MethodsThree systematic literature reviews (SLR) were performed. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented herein covers the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) as well as diagnostic testing and general management of all AAV syndromes.ResultsFor the treatment of EGPA, diagnostic procedures and general management 3517, 4137 and 4215 articles were screened and 26, 110 and 63 articles were included in the final evidence syntheses, respectively. For EGPA patients with newly diagnosed disease without unfavourable prognostic factors, azathioprine (AZA) combined with glucocorticoids (GC) is not superior to GC monotherapy to induce remission (LoE 2b). In patients with active EGPA and unfavourable prognostic factors, cyclophosphamide or rituximab can be used for remission induction (LoE 2b). Treatment with Mepolizumab added to standard treatment results in higher rates of sustained remission in patients with relapsing or refractory EGPA without active organ-threatening or life-threatening manifestations (LoE 1b) and reduces GC use. Kidney biopsies have prognostic value in AAV patients with renal involvement (LoE 2a). In the context of suspected AAV, immunoassays for proteinase 3 and myeloperoxidase-ANCA have higher diagnostic accuracy compared with indirect immunofluorescent testing (LoE 1a).ConclusionThis SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.

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Comparison of the factors associated with the short-term prognosis between elderly and non-elderly patients with anti-neutrophil cytoplasmic antibody-associated vasculitis: a retrospective observational study

Cited by 4 publications

References 0 publications

Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Association between different infection profiles and one-year outcomes in ANCA-associated vasculitis: a retrospective study with monthly infection screening

Therapieansprechen und Komplikationen von älteren Patienten mit ANCA(antineutrophile cytoplasmatische Antikörper)-assoziierten Vaskulitiden

Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): Part 2 - Treatment of eosinophilic granulomatosis with polyangiitis and diagnosis and general management of AAV

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