Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Standard management of ANCA-associated vasculitis (AAV) involves treatment with immunosuppressive agents for at least 18 months. Treatment beyond 18 months reduces the rates of relapses but effect on health-related quality of life (HRQoL) is not known. The objective of this study was to assess the effect of treatment with immunosuppressive agents on HRQoL among patients with AAV that have had a sustained remission for at least 18 months.
Methods: Data from a multicenter longitudinal study of patients with AAV were used. Subjects came for quarterly- or annually-scheduled study visits. Disease activity was assessed by the Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BVAS/WG), and medication use was recorded. Recording of ANCA status, previous disease flares, and a comprehensive cumulative list of disease manifestations was done at the initial study visit. Sustained remission was defined as enrollment in the cohort for 18 consecutive months without any detectable disease activity. Immunosuppressive medication use was defined as use of azathioprine, infliximab, methotrexate, mycophenolate mofetil, or rituximab. HRQoL was assessed with the physical component (PCS) and mental (MCS) summary scores of the Short Form 36 (SF-36) which have a normal distribution with a mean of 50 and standard deviation of 10 in the general population. The effect of immunosuppressive treatment was calculated with a linear regression model adjusted for age and sex, and additionally adjusted for ANCA type, organ involvement, and previous history of disease flare. General estimating equations were used to account for multiple visits from each subject.
Results: Data from 434 subjects that came for 1,679 study visits were used. At 979 visits (59%) subjects were receiving immunosuppressive agents. The median follow-up time was 1.84 years (Inter-Quartile Range 0.73 – 3.25). The mean age was 55.3 years (standard deviation 14.8) and 55% were women. The mean SF36 scores in were 43.8 and 50.3 for PCS and MCS, respectively. Use of immunosuppressive agents was associated with 2.17 (p=0.02) lower score for PCS and 0.43 (p=0.64) lower scores for MCS. Additional adjustment for ANCA type, organ involvement, and previous history of disease flare minimally affected the findings with 1.97 (p=0.03) and 0.28 (p=0.61) lower scores for PCS and MCS, respectively.
Conclusion: Among patients with AAV who have had sustained remission for 18 months long-term use of continued immunosuppressive medications is not associated with additional improvement in HRQoL.
To cite this abstract in AMA style:Tomasson G, Sreih AG, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Seo P, Specks U, Ytterberg SR, Merkel PA. The Effect on Health-Related Quality of Life of Treatment for Remission Maintenance in ANCA-Associated Vasculitis Beyond 18 Months [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-effect-on-health-related-quality-of-life-of-treatment-for-remission-maintenance-in-anca-associated-vasculitis-beyond-18-months/. Accessed September 19, 2021.
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