Abstract: SA-PO259

Relapse Free Survival after Steroid Withdrawal in ANCA Vasculitis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • LIOUDAKI, Eirini, ST HELIER HOSPITAL, London, United Kingdom
  • Condon, Marie B., St. Helier Hospital, Surrey, United Kingdom
  • Rashid, Lubna, St Helier Hospital, London, United Kingdom
  • Harris, Fiona E., Epsom and St Helier NHS Trust, Surrey, United Kingdom
  • Makanjuola, David, St. Helier Hospital, Surrey, United Kingdom
  • Sood, Bhrigu Raj, South West Thames Renal Unit, Carshalton, sURREY, United Kingdom
Background

Current immunosuppressive regimens have made a marked difference to patient and organ survival; toxicity associated with long term treatment is recognised. Withdrawal of treatment is associated with disease relapse. It is unclear if there are cohorts of patients in whom immunosuppression can be withdrawn and if so when. We report, from our centre on the long term outcomes on 93 patients(pts) in whom steroid maintenance treatment was withdrawn after a stable remission was achieved.

Methods

93 pts identified from a long term cohort of 219 pts presenting over a 13 year period. Data collected from medical records. Follow up ranged from 6 - 168 mths (median 60mths). Remission was achieved with standard induction (Plasma Exchange, Cyclophosphamide (cyclo) (oral or intravenous), mycophenolate mofetil (MMF) or Rituximab; all in combination with corticosteroid) and maintained with Azathioprine or MMF in combination with corticosteroid. In patients in whom a stable remission was achieved, withdrawal of corticosteroid would begin at 18 to 24 mths.We have looked at steroid withdrawal and subsequent disease activity.

Results

38 female; 87 white ethinicity; median age at diagnosis of 69 yrs (range 18-89). Median creatinine (creat) at presentation was 309umol/L; 22 pts with a serum creat >500.
Induction: 86 pts cyclo (6 oral, 80 IV); 1 Rituximab, 1 Azathioprine, 5 MMF. 30 pts received plasma exchange.
Median time to cessation of prednisolone from induction was 25mths (4-93). 72 pts (77%) remain relapse free at a median of 39 months since steroid withdrawal (3-126). Antibody class or induction treatment did not predict relapse free status; neither did presentation renal function (median creat 309 in non relapse pts / creat 330 in relapse). Follow up of patients who had relapsed was longer than for those who are disease free; 110 (53-163) versus 66 (14-165) mths, however 62 patients have remained disease free for over 18mths off steroid. (median 24 (range 4-93)).

Conclusion

In this cohort we have so far not identified a clear predictor of steroid withdrawal without relapse, however 77% of our patients remain relapse free off steroid with significant follow up period. We would suggest that withdrawal of steroid should be the aim when patients have achieved a stable remission, and that this can be achieved safely with close monitoring.