ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1943

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: ,

Session Information

Date: Monday, November 14, 2016

Session 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 March 21, 2023.

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