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Abstract Number: 1928

Treatment of ANCA Associated Vasculitis in the Very Elderly

Omer Ali1, Kelly Ameneshoa2, Maire Condon1, Sanjeev Patel3, Bhrigu Sood2, David Makanjuola1 and Fiona Harris2, 1Renal, St Helier hospital, London, United Kingdom, 2St Helier hospital, London, United Kingdom, 3Rheumatology, St Helier University Hospital, London, United Kingdom

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ANCA and vasculitis

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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: Anti-neutrophil cytoplasmic antibody associated vasculitis (AAV) are a group of disorders predominantly affecting older patients and frequently presenting with acute kidney injury. Despite the improvements made in treating these disorders, appropriate treatment strategies in the very elderly (above the age of 80) remain undefined, as the majority of clinical trials have excluded this age group and therefore it is still unclear whether the benefits of immunosuppression outweigh the risks.

Methods: We retrospectively examined 31 cases who presented with AAV and acute kidney injury in individuals aged >80 between 2006 to 2015 with a mean follow up of 39 months

Results: 32% were PR3 positive, 58% MPO positive and 10% negative. Mean creatinine at presentation was 367 mmol/L and 48% required acute dialysis on presentation. 68% of patients were treated with Cyclophosphamide as induction therapy while 16% received Azathioprine and steroids. Infection was documented in 33% of patients. Survival rate at one year was 76% and the incidence of end-stage kidney disease was 52%.

Number 31
Age 83 ± 2.7
Female 66.7%
Ethnicity: White Asians 94% 6%
Mean creatinine at presentation (µmol/l) 367
Dialysis at presentation 48%
Plasma exchange 22%
Induction Cyclophosphamide and steroids Azathioprine and steroids None 68% 16% 16%
Maintenance: Azathioprine and Steroids Mycophenolate Mofetil and steroids Steroids only None 32% 12% 26% 30%
Patient survival 1 year 76%
Renal Survival 1 year 52%

Conclusion:   The results of this study show that a significant percentage of the very elderly patients can benefit from immunosuppresion therapy for AAV, despite the higher risks of adverse effects from these medications. However the precise details of what to give and for how long remains unclear.


Disclosure: O. Ali, None; K. Ameneshoa, None; M. Condon, None; S. Patel, None; B. Sood, None; D. Makanjuola, None; F. Harris, None.

To cite this abstract in AMA style:

Ali O, Ameneshoa K, Condon M, Patel S, Sood B, Makanjuola D, Harris F. Treatment of ANCA Associated Vasculitis in the Very Elderly [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/treatment-of-anca-associated-vasculitis-in-the-very-elderly/. Accessed February 2, 2023.
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