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Abstract Number: 2717

Factors Predicting Severe Infections in Patients with Systemic Necrotizing Vasculitides Based on Data from 733 Patients Enrolled in Randomized–Controlled Trials

Lafarge Antoine1, Christian Pagnoux2, Xavier Puéchal3, Maxime Samson4, Mohamed Hamidou5, Alexandre Karras6, Thomas Quémeneur7, Matthieu Groh8, Luc Mouthon3, Loïc Guillevin3 and Benjamin Terrier9, 1Medecine Interne, National Referral Center for Rare Systemic Autoimmune Diseases, Paris Cochin, France, Paris, France, 2Division of Rheumatology, Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada, 3Department of Internal Medicine, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, National Referral Center for Rare Systemic Autoimmune Diseases, Paris Cochin, France, Paris, France, 4Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France, 5Department of Internal Medicine, CHU de Nantes, France, Nantes, France, 6Department of Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France, Paris, France, 7Department of Internal Medicine, CH of Valenciennes, France, Valenciennes, France, 8Internal Medicine, Foch, Suresnes, France, 9National Referral Center for Rare Systemic Autoimmune Diseases, Paris Cochin, France, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: immunosuppressants, Infection, tolerance and vasculitis

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Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis – ANCA-Associated Poster II

Session Type: ACR Poster Session C

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

Background/Purpose: Although overall survival of patients with systemic necrotizing vasculitides (SNVs) has improved markedly over the last 20 years, infectious complications remain a major cause of morbidity and mortality. This study aimed to identify factors predicting severe infections in SNV patients and assess the impact of the different therapeutic regimens.

Methods: Data were pooled from 5 randomized–controlled trials conducted by the FVSG—CHUSPAN1, CHUSPAN2, WEGENT, CORTAGE, MAINRITSAN—that enrolled 733 patients between 1993 and 2012. Those trials evaluated therapeutic strategies to treat polyarteritis nodosa (PAN), granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and/or eosinophilic granulomatosis with polyangiitis (EGPA). The primary endpoint of this study was the occurrence of severe infection, defined as a severe adverse event, requiring hospitalization, intravenous antibiotics and/or resulting in death. Univariate and multivariate analyses were computed to identify associations between baseline characteristics and 2- and 5-year severe infection rates.

Results: SNV diagnoses were: 238 (32.5%) MPA, 224 (30.6%) GPA, 186 (25.4%) EGPA and 85 (11.6%) PAN. Baseline characteristics were: mean ± SD age 58 ± 12 years, 55% men, 61% with pulmonary involvement, 55% with nervous system involvement, Five Factor Score = 0 for 59%, glomerular filtration rate <60 ml/min in 35%. Induction therapies were glucocorticoids alone (15%), glucocorticoids & azathioprine (16%) or glucocorticoids & cyclophosphamide (69%). Maintenance regimens were azathioprine for 28% of the patients, methotrexate for 9%, rituximab for 8% or none for 55%. After median follow-up of 5.2 (IQR 3–9.7) years, 148 (20.2%) patients experienced ≥1 severe infection(s). Median inclusion-to-severe-infection interval was 14.9 (4.3–51.7) months. Among all severe infections 48% were bronchopulmonary and 57% were bacterial. Patients with ≥1 severe infection(s) had a higher risk of death (22% vs 8%; P<0.001). At 2 years, patients with ≥1 severe infection(s) were older, had more frequent pulmonary involvement, nervous system involvement and FFS >0, and were more likely to have received cyclophosphamide for induction. Multivariate analyses retained pulmonary [OR 2.11 (1.18–3.77); P=0.01] and nervous system involvements [OR 1.82 (1.01–3.30), P=0.048] as independent predictors of severe infection. At 5-years, baseline characteristics were the same for patients with ≥1 severe infection(s) but they had more likely received rituximab for maintenance therapy. Multivariate analyses retained pulmonary involvement [OR 1.71 (1.10–2.65); P=0.02] and age [OR 1.19 (1.02–1.38) per 10 years, P=0.02] as independent predictors of severe infection.

Conclusion: Severe infections, frequent adverse events in SNV patients, mostly occurred >1 year post-inclusion, and substantially impacted mortality. Age and pulmonary involvement were independent predictors of severe infection. Patients who had taken cyclophosphamide or rituximab had more severe infections than other regimens.


Disclosure: L. Antoine, None; C. Pagnoux, None; X. Puéchal, None; M. Samson, None; M. Hamidou, None; A. Karras, None; T. Quémeneur, None; M. Groh, None; L. Mouthon, None; L. Guillevin, None; B. Terrier, None.

To cite this abstract in AMA style:

Antoine L, Pagnoux C, Puéchal X, Samson M, Hamidou M, Karras A, Quémeneur T, Groh M, Mouthon L, Guillevin L, Terrier B. Factors Predicting Severe Infections in Patients with Systemic Necrotizing Vasculitides Based on Data from 733 Patients Enrolled in Randomized–Controlled Trials [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/factors-predicting-severe-infections-in-patients-with-systemic-necrotizing-vasculitides-based-on-data-from-733-patients-enrolled-in-randomized-controlled-trials/. Accessed .
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