Background/Purpose: Co-prescribing mesna with CYC for AAV aims to prevent the potential urotoxic effects of CYC. We investigated current clinical practice related to prescribing mesna prophylaxis or not for CYC-treated patients with AAV.

Methods: We searched MEDLINE for publications with the MeSH term “ANCA-associated vasculitis” over a 10-year period. Email addresses of authors were extracted from the online information. These authors were invited by email to participate in an online SurveyMonkey® survey asking about the characteristics of the respondent, their experience with AAV, and their practice in using CYC to treat AAV and in using mesna in CYC-treated patients with AAV and the underlying rationale. We compared 15 response variables to identify factors associated with the use of mesna. Response variables with multiple categories were first analyzed across all categories; if the omnibus test result was significant, additional analyses were used to identify the categories, which were the sources of group separation. Statistical analyses involved Pearson’s chi-square test or Fisher’s exact test. For multiple-response variables, the Rao-Scott correction was applied.

Results: The 139 participants were from 34 countries and were essentially MDs (98%) who mainly worked in rheumatology (50%), nephrology (25%) or internal medicine/immunology (18%). Mesna was given with CYC systematically, never, or on a case-by-case basis by 68%, 19% and 13% of respondents, respectively. As compared with systematic mesna-prescribers, never/occasional mesna-prescribers reported a longer time since receiving their degree (≥ 15 years: 80% vs 50%, P< 0.001), were more frequently based in England/United States (than in France/Germany/Italy) (78% vs 21%, P< 0.001), had longer involvement in care of patients with AAV (≥15 years: 62% vs 37%, P=0.006), had less practice in using intermittent pulse therapy as the exclusive/predominant CYC administration scheme (62% vs 89%, P< 0.001), and, as a rationale underpinning their mesna practice, had less adherence to local operational procedures (47% vs 73%, P=0.002) or (inter)national management guidelines for AAV (16% vs 49%, P< 0.001).

Conclusion: Practice with regard to prescribing mesna in conjunction with CYC to treat AAV is heterogeneous. Systematic mesna use prevailed over never or occasional use. The decision to prescribe mesna may be based more on circumstantial than structural reasons.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-2-mercaptoethane-sodium-sulfonate-prophylaxis-in-cyclophosphamide-treated-patients-with-anca-associated-vasculitis-results-of-an-electronic-survey/