Risk of Relapse of ANCA-associated Vasculitis in Patients of 75 Years and Older: A Retrospective Study

Sara Thietart¹, Guillaume Beinse², Perrine Smets³, Alexandre Karras⁴, Carole Philipponnet⁵, Jean-François Augusto⁶, Khalil El Karoui⁷, Rafik Mesbah⁸, Dimitri Titeca Beauport⁹, Mohamed Hamidou¹⁰, Pierre-Louis Carron¹¹, Julien Campagne¹², Karim Sacre¹³, Pascal Cohen¹, Eric Liozon¹⁴, Claire Blanchard-Delaunay¹⁵, Alex Kostianovsky¹⁶, Christian Pagnoux¹⁷, Luc Mouthon¹, Loïc Guillevin¹⁸, Benjamin Terrier¹ and Xavier Puéchal for the French Vasculitis Study Group¹, ¹National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris-Descartes University, Paris, France, ²Inserm UMR 1138, Centre de Recherche des Cordeliers, Paris, France, ³Department of Internal Medicine, Centre Hospitalier Universitaire Clermont-Ferrand Hôpital Gabriel-Montpied, Clermont Ferrand, France, ⁴Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France, ⁵Department of Nephrology, CHU Clermont-Ferrand, Clermont-Ferrand, Clermont Ferrand, France, ⁶Department of Nephrology-Dialysis-Transplantation, CHU Angers, Angers, France, ⁷Department of Nephrology and Transplantation, Hôpital Universitaire Henri-Mondor, Creteil, France, ⁸Department of Nephrology, CH Boulogne-sur-Mer, Boulogne-Sur-Mer, France, ⁹Department of Nephrology, Amiens University Medical Center, Amiens, France, ¹⁰Department of Internal Medicine, Hôtel-Dieu, CHU Nantes, Nantes, France, ¹¹Department of Nephrology-Dialysis-Transplantation, CHU Grenoble-Alpes, Grenobles, France, ¹²Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France, ¹³Département de Médecine Interne, Hôpital Bichat, APHP, Paris, France, ¹⁴Department of Internal Medicine and Clinical Immunology, Limoges University Hospital, Limoges, France, ¹⁵Department of Internal Medicine, CH, Niort, France, ¹⁶Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno", Buenos Aeres, Argentina, ¹⁷Vasculitis Clinic, Canadian Network for Research on Vasculitides (CanVasc), Department of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ¹⁸Department of Internal Medecine, National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris-Descartes University, Paris, France

Meeting: ACR Convergence 2020

Keywords: Aging, ANCA associated vasculitis, Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis, Outcome measures

Session Information

Date: Sunday, November 8, 2020

Title: Vasculitis – ANCA-Associated Poster

Session Type: Poster Session C

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

Background/Purpose: ANCA-associated vasculitis (AAV) frequently occurs among older patients, with different clinical presentations than the younger. Little is known on the outcome of older patients presenting with AAV. We aim to study the risk of relapse of patients with an AAV diagnosed after the age of 75 years.

Methods: Data from patients aged ≥65 years were extracted from the prospectively completed French Vasculitis Study Group (FVSG) database and from a call for observation of patients aged ≥75 years sent to the FVSG members on June 2019. Patients were included if they had a diagnosis of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) or unclassified AAV (EMA classification criteria) made after the age of 65 and were either followed-up for 6 months or deceased. Patients aged ≥75 years were compared to those aged 65-75 years. Data on comorbidities, demography, disease phenotype, treatment, and outcome were collected. Primary end-point was risk of first relapse among those who achieved remission. To assess relapse risk, univariate and multivariate analysis was performed, using both Cox (using cause-specific hazard ratios, CSHR) and Fine- Gray models (using sub-distribution HR, SHR), taking death into account as a competing risk for relapse.

Results: We included 299 patients, 219 patients aged ≥75 years (median 79, IQR [77-83], 79 from the database and 140 from the call for observations) and 80 patients aged 65-75 years (median 70 years, IQR [68-72]) from the database. Diagnosis was GPA for 155 patients (52%), MPA for 136 patients (45%) and unclassified for 8 patients (3%). When compared with patients aged 65-75 years, those aged ≥75 years had lower relapse risks in multivariate analysis (CSHR 0.54, 95% IC 0.33 to 0.89, p=0.016), as well as when death was taken into account as a competing event (SHR 0.46, 95% IC 0.29 to 0.74, p=0.001). Patients aged ≥75 years also had lower relapse risks when adjusting on diagnosis of GPA (CHSR 0.56, 95% IC 0.35 to 0.90, p=0.017; SHR 0.56 95% IC 0.34 to 0.91, p=0.019), on variables composing Five Factor Score (FFS) 1996, as well as on variables composing FFS 2011. Patients aged ≥75 years had a lower risk of being treated with immunosuppressive therapy in addition to glucocorticoids (versus glucocorticoids alone), after adjusting for FFS 1996 (HR 0.29, 95% IC 0.12 to 0.70, p=0.023) and FFS 2011 (HR 0.29, 95% IC 0.12 to 0.71, p=0.007). Patients aged ≥75 years, for whom a combination of immunosuppressants and glucocorticoids is usually recommended and who followed that treatment regimen, had significantly lower relapse rates than those who were treated with glucocorticoids alone (CSHR 0.29, 95% IC 0.12 to 0.68, p=0.005; SHR 0.31, 95% IC 0.13 to 0.71, p=0.006).

Conclusion: Patients with a diagnosis of AAV after the age of 75 years had a lower risk of relapse than patients aged 65-75 years, after adjusting for confounders and using death as a competing risk of relapse. Patients aged ≥75 years had lower probabilities of being treated with a combination of immunosuppressants and glucocorticoids. However, patients aged ≥75 years still benefit from being treated with immunosuppressants and glucocorticoids when recommended, with a lower relapse risk.

Disclosure: S. Thietart, None; G. Beinse, None; P. Smets, None; A. Karras, None; C. Philipponnet, None; J. Augusto, None; K. El Karoui, None; R. Mesbah, None; D. Titeca Beauport, None; M. Hamidou, None; P. Carron, None; J. Campagne, None; K. Sacre, None; P. Cohen, None; E. Liozon, None; C. Blanchard-Delaunay, None; A. Kostianovsky, None; C. Pagnoux, chemocentryx, 1, roche, 1, 2, GSK, 1, 2, Janssen, 1, Sanofi, 5; L. Mouthon, None; L. Guillevin, None; B. Terrier, None; X. Puéchal for the French Vasculitis Study Group, Roche Pharma, 1.

To cite this abstract in AMA style:

Thietart S, Beinse G, Smets P, Karras A, Philipponnet C, Augusto J, El Karoui K, Mesbah R, Titeca Beauport D, Hamidou M, Carron P, Campagne J, Sacre K, Cohen P, Liozon E, Blanchard-Delaunay C, Kostianovsky A, Pagnoux C, Mouthon L, Guillevin L, Terrier B, Puéchal for the French Vasculitis Study Group X. Risk of Relapse of ANCA-associated Vasculitis in Patients of 75 Years and Older: A Retrospective Study [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/risk-of-relapse-of-anca-associated-vasculitis-in-patients-of-75-years-and-older-a-retrospective-study/. Accessed .

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-relapse-of-anca-associated-vasculitis-in-patients-of-75-years-and-older-a-retrospective-study/