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.
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 August 5, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-relapse-of-anca-associated-vasculitis-in-patients-of-75-years-and-older-a-retrospective-study/