Risk factors for relapse of antineutrophil cytoplasmic antibody–associated vasculitis

Abstract

on behalf of the European Vasculitis Study GroupObjective. To determine the association between characteristics at diagnosis and the time to first relapse in a large cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods. We studied long-term followup data from 4 clinical trials that included newly diagnosed patients with a broad spectrum of AAV severity and manifestations. Patient and disease characteristics at baseline were used in competing risk regression models with relapse as the event of interest and death as the competing event.Results. We assessed 535 patients with 1,804 patient-years at risk of relapse. At diagnosis, the median age was 60. Conclusion. Relapse of disease is common for patients with AAV. A creatinine level >200 moles/liter at the time of diagnosis is strongly associated with a reduced risk of relapse and may help guide monitoring and treatment of patients with AAV.

Long‐Term Outcomes Among Participants in the WEGENT Trial of Remission‐Maintenance Therapy for Granulomatosis With Polyangiitis (Wegener's) or Microscopic Polyangiitis

“…Anti-PR3 ANCA positivity has repeatedly been shown to be associated with a higher risk of relapse in cohorts of AAV patients (39)(40)(41)(42) or in other randomized controlled trials (43)(44)(45), which is consistent with our findings. Although patients with GPA reportedly experienced relapses more frequently than did those with MPA in one study (10), it must be emphasized that in our multivariate analysis, positivity for anti-PR3 ANCAs at baseline, but not GPA, was retained as being independently and significantly prognostic of recurrent relapses and, thus, negatively affected the rates of relapse-free survival.…”

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

“…Positivity for PR3-ANCA has repeatedly been identified as an independent risk factor for a relapse during follow up [26,[29][30][31][32][33][34][35]. A diagnosis of GPA, as well as lung involvement or upper respiratory tract involvement is related to a higher relapse risk [30,31,[36][37][38].…”

“…>200 μmol/l) tend to relapse less often than patients with a lower serum creatinine level [35,38]. Cardiovascular involvement has been identified as a predictor of a relapse [35]. In a small study, infection has been reported to be a risk factor for GPA [39].…”

“…Patients with a high serum creatinine level (e.g. >200 μmol/l) tend to relapse less often than patients with a lower serum creatinine level [35,38]. Cardiovascular involvement has been identified as a predictor of a relapse [35].…”

L23. Renal transplantation in ANCA-associated vasculitis

“…About 50% of patients experience a relapse within 5 years of diagnosis, and the risk is a major concern with respect to transplantation (21). A renal relapse can rapidly destroy a graft and confront the patient with substantial risks for additional morbidity (22).…”