ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 0443

Prognosis of Non-PR3 ANCA-Associated Vasculitis with Glomerulonephritis

Aurélien Chepy1, Hélène Béhal2, Alexandre Karras3, Xavier Puéchal4, Benjamin Terrier4, David Jayne5, Thomas Quéméneur6 and Mary-Jane Guerry7, 1CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France, 2University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France, 3HEGP, Paris, France, 4National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris, France, 5University of Cambridge, Cambridge, United Kingdom, 6Valenciennes Hospital, Valenciennes, France, 7Department of Nephrology, Centre Hospitalier de Valenciennes, Valenciennes., Valenciennes, France

Meeting: ACR Convergence 2022

Keywords: ANCA, ANCA associated vasculitis, autoimmune diseases, Nephritis, Vasculitis

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
Session Information

Date: Saturday, November 12, 2022

Title: Vasculitis – ANCA-Associated Poster I: Epidemiology, Outcomes, and Classification

Session Type: Poster Session A

Session Time: 1:00PM-3:00PM

Background/Purpose: Immunosuppressive treatments have improved the prognosis of anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV), transforming these formerly fatal diseases into chronic conditions, with periods of remission and relapse.

Relapse prevention is based on remission-maintenance immunosuppressive treatment with a usual duration of 18 to 24 months. However, prolonged maintenance treatment may not be necessary for all patients. On the one hand, MPO-ANCA (vs PR3-ANCA) and decreased estimated glomerular filtration rate (eGFR) have been associated with a low risk of relapse. On the other hand, treatment of AAV is not devoid of risk. Thus, it has been well demonstrated that patients with renal AAV without PR3 ANCA have the lowest risk of relapse and the highest mortality rate.

This study aimed to determine: first, the risk of late relapse in AAV patients with renal involvement and without PR3-ANCA after end of remission-maintenance treatment, and second, risk factors for relapse in this population.

Methods: Patients with renal involvement without PR3-ANCA recruited to prospective, randomised trials of the European Vasculitis Study group (EUVAS): CYCAZAREM, CYCLOPS, MEPEX, IMPROVE and the French Vasculitis Study Group (FVSG): WEGENT were included in the analysis if their disease was in remission at the end of relapse-prevention therapy. This consisted in azathioprine, methotrexate or mycophenolate mofetil and was stopped after 18-24 months (around 24-27 months after diagnosis).

Results: One hundred and eightpatients were included, 64 of whom (59.3%) were male, 79 were MPO-ANCA positive (73.1%) and 29 ANCA negative (26.9%). Average age at diagnosis was 59.6 +/- 12.4 years. Relapse rate was 25.5% 60 months after cessation of maintenance treatment (figure 1) of which 46.2% were renal relapses (figure 2). Lower GFR at diagnosis was correlated with a lower risk of relapse. For every 15-point decrease in GFR at diagnosis, the risk of relapse decreased by a factor of 0.72 (HR 95% CI: 0.59 to 0.88). Figure 3 represents the cumulative incidence of relapse by eGFR level. Relapse risk did not appear to be impacted by the presence at diagnosis of systemic/constitutional (HR: 0.70; CI 95%: 0.30-1.65; p: 0.47), lung (HR: 0.87; CI 95%: 0.40-1.86; p: 0.71), skin involvement (HR: 0.84;CI 95%: 0.29-2.39; p: 0.74), ear, nose and throat (HR: 1.53; CI 95%: 0.74-3.27; p: 0.28) or eye disease (HR: 1.58; CI 95%: 0.62-4.10; p: 0.34). Presence of MPO-ANCA at diagnosis did not influence relapse-risk.

Conclusion: Even in this population of renal AAV without PR3-ANCA, there remains a risk of late relapse, after the end of a two-year conventional maintenance regimen. Using additional criteria (such as eGFR at diagnosis < or > 45 ml/min/1.73m2) could help select a group of patients who are at lower risk of relapse. Factors that potentially increase (ENT or eye disease) risk of relapse need to be explored further. If these data are confirmed, sub-groups could be identified who could receive only a short maintenance treatment, or perhaps none. These findings also need to be to be analysed following rituximab maintenance.

Supporting image 1

Cumulative incidence of relapse over time

Supporting image 2

Cumulative incidence of renal relapse over time

Supporting image 3

Cumulative incidence of relapse by eGFR level (1:<15 / 2 :15_30 / 3 :30_45 / 4:>=45 ml/min/1.73m2)


Disclosures: A. Chepy, None; H. Béhal, None; A. Karras, Roche, Gilead, Amgen; X. Puéchal, Roche; B. Terrier, AstraZeneca, GlaxoSmithKline, Bristol-Myers Squibb(BMS), Eli Lilly, LFB, Boehinger Ingelheim, Vifor Pharma, Pfizer, Roche; D. Jayne, Aurinia, AstraZeneca, GlaxoSmithKline (GSK), Roche/Genentech, Vifor, Bristol-Myers Squibb(BMS), Chemocentryx, Novartis, Takeda, Boehringer-Ingelheim, Otsuka, UCB, Amgen, Kessai; T. Quéméneur, Roche; M. Guerry, None.

To cite this abstract in AMA style:

Chepy A, Béhal H, Karras A, Puéchal X, Terrier B, Jayne D, Quéméneur T, Guerry M. Prognosis of Non-PR3 ANCA-Associated Vasculitis with Glomerulonephritis [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/prognosis-of-non-pr3-anca-associated-vasculitis-with-glomerulonephritis/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to ACR Convergence 2022

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prognosis-of-non-pr3-anca-associated-vasculitis-with-glomerulonephritis/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology