Patients of 75 years and over with ANCA‐associated vasculitis have a lower relapse risk than younger patients: A multicentre cohort study

Thietart, Sara; Beinse, Guillaume; Smets, P.; Karras, Alexandre; Philipponnet, Carole; Augusto, Jean‐François; Karoui, Khalil El; Mesbah, Rafik; Titeca-Beauport, Dimitri; Hamidou, M.; Carron, Pierre-Louis; Maurier, F.; Sacré, Karim; Cohen, Pascal; Liozon, É.; Blanchard-Delaunay, Claire; Kostianovsky, Alex; Pagnoux, Christian; Mouthon, Luc; Guillevin, Loı̈c; Terrier, B.; Puéchal, Xavier

doi:10.1111/joim.13417

Cited by 8 publications

(13 citation statements)

References 45 publications

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“…By contrast, we were able to identify that an age ≤75 years at AAV diagnosis was independently associated with an increased risk of relapse, which was also confirmed by the FVSG in a recently published study. 29 It is likely that this finding was not previously identified because patients aged over 80 years were not included in European Vasculitis Society (EUVAS) therapeutic trials, 19 which was not the case in the present work since the CORTAGE study, which was specifically designed for elderly individuals, enrolled 83 patients. 10 Age could also explain why the performance of the FRS was better in the validation cohort than in the development cohort since the mean age at diagnosis of the validation cohort was 78 years.…”

Section: Discussionmentioning

confidence: 86%

“…The validation cohort included AAV patients aged ≥65 years from the FVSG registry database. 29 Patients were included if they had a new diagnosis of GPA or MPA made after 2000, according to the revised Chapel Hill Consensus Conference, 1 and if they were either followed up for at least 6 months and/or were deceased. Duplicates with the development cohort were removed from the validation cohort.…”

Section: Methodsmentioning

confidence: 99%

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Score to assess the probability of relapse in granulomatosis with polyangiitis and microscopic polyangiitis

et al. 2023

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ObjectiveTo develop a score assessing the probability of relapse in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA).MethodsLong-term follow-up data from GPA and MPA patients included in five consecutive randomised controlled trials were pooled. Patient characteristics at diagnosis were entered into a competing-risks model, with relapse as the event of interest and death the competing event. Univariate and multivariate analyses were computed to identify variables associated with relapse and build a score, which was then validated in an independent cohort of GPA or MPA patients.ResultsData collected from 427 patients (203 GPA, 224 MPA) at diagnosis were included. Mean±SD follow-up was 80.6±51.3 months; 207 (48.5%) patients experienced ≥1 relapse. Relapse risk was associated with proteinase 3 (PR3) positivity (HR=1.81 (95% CI 1.28 to 2.57); p<0.001), age ≤75 years (HR=1.89 (95% CI 1.15 to 3.13); p=0.012) and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m² (HR=1.67 (95% CI 1.18 to 2.33); p=0.004) at diagnosis. A score, the French Vasculitis Study Group Relapse Score (FRS), from 0 to 3 points was modelised: 1 point each for PR3-antineutrophil cytoplasmic antibody positivity, eGFR ≥30 mL/min/1.73 m² and age ≤75 years. In the validation cohort of 209 patients, the 5-year relapse risk was 8% for a FRS of 0, 30% for 1, 48% for 2 and 76% for 3.ConclusionThe FRS can be used at diagnosis to assess the relapse risk in patients with GPA or MPA. Its value for tailoring the duration of maintenance therapy should be evaluated in future prospective trials.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Score to assess the probability of relapse in granulomatosis with polyangiitis and microscopic polyangiitis

et al. 2023

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“…This multicenter cohort study used data from a prospectively collected database enriched with information from a call for observation with a retrospective data collection. 7 Data from patients 65 years and older with ANCA-associated vasculitis were extracted from the French Vasculitis Study Group registry, in which all consecutive patients with incident ANCA-associated vasculitis from January 1, 2000, to July 1, 2018, were included. In addition, data were obtained from a call for observation of patients 75 years and older sent to French Vasculitis Study Group members on June 6, 2019.…”

Section: Methodsmentioning

confidence: 99%

“… 2 , 3 , 4 Clinical presentation differs between older and younger patients. Microscopic polyangiitis is more frequently diagnosed in the older population, 5 , 6 , 7 , 8 with more frequent comorbidities, kidney involvement, and antimyeloperoxidase antibody positivity and less ear, nose, and throat involvement. Outcomes also differ, with older individuals having higher infection and mortality rates 6 , 9 , 10 but a lower risk of relapse.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

et al. 2022

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Key Points Question What outcomes and adverse events are associated with rituximab use among patients 75 years and older with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis? Findings In this cohort study of 93 patients 75 years and older with ANCA-associated vasculitis, induction therapy combining rituximab and high-dose glucocorticoid regimens was associated with achievement of remission but accompanied by a high rate of serious infections (46.6 per 100 patient-years). When rituximab was used as maintenance therapy, relapse rates (1.8 per 100 patient-years) and serious infection rates (8.4 per 100 patient-years) were low. Meaning These results suggest that rituximab therapy may be associated with disease remission and prevention of relapse in patients 75 years and older but that efforts focused on reducing infections during induction therapy are needed.

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The Association Between Age at Diagnosis and Disease Characteristics and Damage in Patients With ANCA‐Associated Vasculitis

Bloom,

Pickett‐Nairn,

Silveira

et al. 2023

Arthritis & Rheumatology

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ObjectiveThis study examined the relationship between age at diagnosis and disease characteristics and damage in patients with ANCA‐associated vasculitis (AAV).MethodsAnalysis of a prospective longitudinal cohort of patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA) in the Vasculitis Clinical Research Consortium (2013‐2021). Disease cohorts were divided by age at diagnosis (years): children (< 18), young adults (18‐40), middle‐aged adults (> 40‐65), and older adults (> 65). Data included demographics, ANCA type, clinical characteristics, Vasculitis Damage Index (VDI) scores, ANCA Vasculitis Index of Damage (AVID) scores, and novel disease‐specific and non‐disease‐specific damage scores built from VDI and AVID items.ResultsAnalysis included data from 1020 patients with GPA/MPA and 357 with EGPA. Female predominance in GPA/MPA decreased with age at diagnosis. AAV in childhood was more often GPA and PR3‐ANCA positive. Children with GPA/MPA experienced more subglottic stenosis and alveolar hemorrhage, Children/young adults with EGPA experienced more alveolar hemorrhage, need for intubation, and gastrointestinal involvement. Older adults (GPA/MPA) had more neurologic manifestations. After adjusting for disease duration, medications, tobacco, and ANCA, all damage scores increased with age at diagnosis for GPA/MPA (p < 0.001) except the disease‐specific damage score which did not differ (p = 0.44). For EGPA, VDI scores increased with age at diagnosis (p < 0.009) while all other scores were not significantly different.ConclusionAge at diagnosis is associated with clinical characteristics in AAV. While VDI and AVID scores increase with age at diagnosis, this is driven by non‐disease‐specific damage items.image

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Patients of 75 years and over with ANCA‐associated vasculitis have a lower relapse risk than younger patients: A multicentre cohort study

Abstract: Thietart S, Beinse G, Smets P, Karras A, Philipponnet C, Augusto J, et al. Patients of 75 years and over with ANCA-associated vasculitis have a lower relapse risk than younger patients: A multicentre cohort study.

Cited by 8 publications

References 45 publications

Score to assess the probability of relapse in granulomatosis with polyangiitis and microscopic polyangiitis

Score to assess the probability of relapse in granulomatosis with polyangiitis and microscopic polyangiitis

Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

The Association Between Age at Diagnosis and Disease Characteristics and Damage in Patients With ANCA‐Associated Vasculitis

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