Anoek A E de Joode1, Jan Stephan F Sanders1, Xavier Puéchal2, Loic P Guillevin3, Thomas F Hiemstra4, Oliver Flossmann5, Nils Rasmussen6, Kerstin Westman7, David R Jayne8, Coen A Stegeman1. 1. Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands. 2. Department of Internal Medicine, Hôpital Cochin. 3. National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, University Paris-Descartes, Paris, France. 4. Department of Internal Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge and Lupus and Vasculitis Unit, Cambridge. 5. Department of Nephrology, Royal Berkshire Hospital, Berkshire, UK. 6. Department of Ear, Nose and Throat, Rigshospitalet, Copenhagen, Denmark. 7. Department of Nephrology and Transplantation, Lund University Hospital, Malmö, Sweden. 8. Department of Internal Medicine and Nephrology, University of Cambridge and Lupus and Vasculitis Unit, Cambridge, UK.
Abstract
Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Methods: Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. Results: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Conclusion: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
Objective: We studied whether in ANCA-associated vasculitispatients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Methods: Three hundred and eighty newly diagnosed ANCA-associated vasculitispatients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. Results: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Conclusion: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
Authors: Susan L Hogan; Patrick H Nachman; Caroline J Poulton; Yichun Hu; Lauren N Blazek; Meghan E Free; J Charles Jennette; Ronald J Falk Journal: Kidney Int Rep Date: 2019-01-28
Authors: Catherine King; Katie L Druce; Peter Nightingale; Ellen Kay; Neil Basu; Alan D Salama; Lorraine Harper Journal: Rheumatol Adv Pract Date: 2021-03-09