Background/Purpose: AAV is a severe systemic vasculitis and rapid induction of remission is essential and  high dose glucocorticoids (GC) are part of standard of care. Achieving control of AAV is critical but patients are also at risk from GC-related adverse events leading to long term organ damage as well as acute morbidity and mortality. This retrospective study aimed to examine GC prescribing patterns, AAV response and adverse events (AEs) in incident AAV patients managed in routine clinical practice in Europe.

Methods: 929 incident AAV patients (54% of patients had granulomatosis with polyangiitis, and 46% had microscopic polyangiitis; mean age was 56.82 years (SD 14.2) with 53.7% male)  from 4 European countries (399 physicians) were diagnosed between 2014-17. Routine clinical data collected at baseline, 1, 3, 6 and 12 months following commencement of induction therapy were collected and analysed.

Results: Severity of vasculitis varied –  12% patients were mild/localized, 54%  moderate systemic and 34% had severe, life threatening vasculitis. Overall 83% of patients received GCs initially – 49% IV followed by oral, 17% oral only and 17% IV only. 43% used a combination of cyclophosphamide and GC, 13% rituximab and GC, 10% only GC with the remainder using other regimes. As BVAS was not used routinely, full clinical response was assessed as no vasculitis activity and GC taper on track. Most patients remained on GCs over 12 months, AAV response was incomplete and AEs were  common especially in first 3 months when GC dose highest. GC dose changes were performed variably and varied geographically – for instance more UK patients had GC reductions at 3 (55%) and 6 months (46%) compared to other countries. At 12 months, of the 61% patients still needing GCs, 34% were receiving < 5mg, 56% 5-10mg, 9% 10-20mg and 2% > 20mg. 67% had no vasculitis activity, 17% local disease only, 11% mild to moderate systemic disease and 6% moderate to severe systemic disease

Conclusion: Most incident AAV patients receive  high dose GCs as part of remission induction therapy, commonly IV initially, and the majority remain on GCs over 12 months. AEs and infections are common especially in the first months when GC dose is high. Clinical response is variable and only a minority of patients at 12 months have full remission of AAV without the clinical need for steroids. New targeted therapeutic approaches are needed to address this unmet medical need in AAV.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/glucocorticoids-in-incident-anca-associated-vasculitis-aav-patients-a-study-of-routine-clinical-practice-in-the-eu-demonstrates-prolonged-use-and-temporal-relationship-to-adverse-events-and-infect/