Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Appropriate treatment for Anti-Neutrophilic Cytoplasm Antibodies (ANCA) Associated Vasculitis (AAV) requires induction and maintenance of remission, while balancing side effects from treatment. The CanVasc (Canadian Vasculitis Research Consortium) guidelines (2015) recommend use of corticosteroids and other immunosuppressive therapies for adequate treatment. However, clinical practices may vary significantly under different models of care. We analyzed the current clinical state of practice for treating ANCA related vasculitides within three different subspecialties, to compare differences in prescribing, in contrast to CanVasc guidelines.
Methods: This study was a retrospective cohort study; patient information was retrieved from databases of rheumatology, pulmonology and nephrology clinics under Alberta Health Services (AHS) in Edmonton. Diagnosis of patients with ANCA-associated systemic vasculitis was based according to the 2012 Chapel Hill Guidelines and use of corticosteroid therapy at diagnosis was the inclusion criteria. Data on demographics, corticosteroid dosage and time to taper, concurrent therapies, and management of recurrences was recorded. The medical subspecialty most responsible for steroid prescribing was also identified.
Results:
|
Subspecialty |
Nephrology |
Pulmonology |
Rheumatology |
P values |
|
# Patients |
59 |
9 |
20 |
|
|
% Males |
46% |
22% |
50% |
0.426 |
|
% Females |
54% |
78% |
50% |
0.426 |
|
% receiving pulse steroid on initial diagnosis |
20.3% |
11.1% |
25% |
0.778 |
|
% of patients experiencing flares (≥1) |
20.3% |
55.6% |
45% |
0.018 |
|
% of patients receiving pulse steroid during a flare |
25% |
0% |
22.2% |
0.0006 |
|
# receiving any steroid therapy during flare |
7 |
6 |
9 |
0.002 |
|
Time from start of therapy to taper (days) |
32 |
50 |
39 |
0.411 |
Conclusion: Differences in clinical practice persist within subspecialties, when managing AAV patients. Our data highlights a shorter duration on initial dose of prednisone dose after diagnosis in Neprology patients with taper within 1 month, compared to a longer duration of the initial prednisone dose in Pulmonology patients. CanVasc guidelines recommend glucocorticoids should be gradually tapered to a dose of 5-10 mg/day within 3-6 months of achieving remission. Our data shows that most patients remained on their initial prednisone dose for a much longer period than recommended, although this may be due to remission not being achieved. During recurrences/flares, adjustment to concurrent therapy was preferred over increasing corticosteroid dose instead. Our study highlights that subspecialties have a different approach to managing AAV patients than CanVasc recommendations. Ensuring that patients receive standard best practice for treatment should be a future goal in vasculitis patient management. Further studies are required to assess the effectiveness and knowledge translation of these practice modules, in support of CanVasc guidelines.
To cite this abstract in AMA style:
Gill I, Madsen N, Hassan I, Yacyshyn E. A Comparison of Current Practice to New Vasculitis Treatment Guidelines [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-comparison-of-current-practice-to-new-vasculitis-treatment-guidelines/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-comparison-of-current-practice-to-new-vasculitis-treatment-guidelines/