Factors Predictive of ANCA-Associated Vasculitis Relapse

Maxime Samson¹, Hervé Devilliers², Xavier Puéchal³, Christian Pagnoux⁴, Pascal Cohen³, Luc Mouthon³, Benjamin Terrier⁵ and Loïc Guillevin³, ¹Department of Internal Medicine and Clinical Immunology, Hôpital François Mitterrand, CHU de Dijon, Dijon, France, ²Department of Internal Medicine and Systemic Diseases, Hôpital François Mitterrand, CHU de Dijon, Dijon, France, ³Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, Paris, France, ⁴Division of Rheumatology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Canada, Toronto, ON, Canada, ⁵National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ANCA, outcomes and vasculitis

Session Information

Date: Monday, November 14, 2016

Title: Vasculitis - Poster II: ANCA-Associated Vasculitis

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: To identify associations between patients’ clinical and biological characteristics at diagnosis of antineutrophil cytoplasmic antibody-associated vasculitides (AAVs), and their relapse during follow-up.

Methods: Long-term follow-up data from 5 FVSG prospective trials (CHUSPAN I, CHUSPAN II, CORTAGE, MAINRITSAN and WEGENT) were pooled. Relapses were defined as the recurrence and/or appearance of ≥1 new vasculitis manifestation(s) after remission lasting ≥3 months. For eosinophilic granulomatosis with polyangiitis (EGPA), relapses were defined as new appearance, recurrence or worsening of clinical EGPA manifestation(s) (excluding asthma and/or ENT), requiring the addition, change or dose increase of glucocorticoids and/or other immunosuppressants. Patient and disease characteristics at enrollment were entered into a competing-risks model (1), with relapse as the event of interest and death the competing event. Times to relapse and/or death were calculated from treatment onset and analyses were stratified for the randomization group in each trial. Univariate and multivariate analyses were computed.

Results: Patients with PAN (n=108) and those included during a relapse of a formerly diagnosed AAV (n=23) were excluded. Finally, the characteristics of 610 patients (183 EGPA, 203 granulomatosis with polyangiitis [GPA] and 224 microscopic polyangiitis [MPA]) were included in the analyses. Mean±SD follow-up was 74.6±50.5 months. At diagnosis, mean±SD age was 59.6±15.2 years and mean creatinine 154±164 µmol/L. Anti-proteinase–3 (PR3) and anti-myeloperoxidase (MPO) ANCA were detected in 170 (28%) and 244 (40%) patients, respectively; ANCA or ELISA were negative for 195 (32%) patients and unavailable for 1 MPA patient. During follow-up, 267 (43.8%) patients relapsed and 106 (17.3%) died, 67 of them without prior relapse. A higher relapse risk was independently associated with arthralgias/myalgias (subhazard ratio [sHR]=1.41; P=0.017), anti-PR3 ANCA (sHR=1.91; P=0.010) or anti-MPO (sHR=1.49; P=0.022) ANCA, but the relapse risk was lower for age >70 years (sHR=0.68; P=0.025) or creatinine >200 µmol/L (sHR=0.60; P=0.010) at disease diagnosis.

Conclusion: For GPA, MPA and EGPA patients, relapse risk was lower for age >70 years or creatinine >200 µmol/L at disease onset, but higher for arthralgias/myalgias, anti-MPO ANCA or especially anti-PR3 ANCA. These results should enable us to develop a score predictive of AAV relapse that could help clinicians determine the best adapted maintenance treatment for each patient. Reference 1. Fine JP et al. J Am Stat Assoc 1999;94:496–509

Disclosure: M. Samson, None; H. Devilliers, None; X. Puéchal, None; C. Pagnoux, None; P. Cohen, None; L. Mouthon, None; B. Terrier, None; L. Guillevin, None.

To cite this abstract in AMA style:

Samson M, Devilliers H, Puéchal X, Pagnoux C, Cohen P, Mouthon L, Terrier B, Guillevin L. Factors Predictive of ANCA-Associated Vasculitis Relapse [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/factors-predictive-of-anca-associated-vasculitis-relapse/. Accessed .

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