Abstract: FR-PO932
ANCA Associated Vasculitis and Treatment Associated Morbidity in the Very Elderly – A Single Centre Experience
Session Information
- Geriatric Nephrology
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Geriatric Nephrology
- 901 Geriatric Nephrology
Authors
- Chaggar, Turren tarun Singh, Epsom and St Helier NHS Trust, London, United Kingdom
- Condon, Marie B., St. Helier Hospital, Surrey, United Kingdom
- Makanjuola, David, St. Helier Hospital, Surrey, United Kingdom
Background
ANCA-associated vasculitis presents in later life and is not uncommon in the very elderly (>80 years) patients, but published data concerning the safety and tolerability is lacking. Concerns about treatment toxicity and tolerability may be a barrier to starting appropriate immunosuppression.
Methods
Retrospective review of our local database identified all patients presenting between 2006 and 2015 with ANCA associated vasculitis, and data from those aged >=80 at presentation were analysed for the purposes of this study. Follow-up was until May 2017 or death. The incidence of treatment related complications; leucopaenia and infections was recorded. Survival data were analysed with respect to age, sex, renal function at diagnosis as well as treatment regime used. Cause of death was reviewed where available.
Results
We identified 32 cases with a mean age of 83.5 yrs (range 80-90), mean follow-up period of 35.5 months (range 0.2 – 106). Of these, 14 were PR3 positive and 18 were MPO positive. Mean admission creatinine was 406 µmol/L and 38% (12/32) required RRT within 72 hours. Induction therapy was combined with steroids and 78% received cyclophosphamide (25/32), 6% azathioprine (2/32), 3% MMF (1/32) and 3% rituximab. Maintenance therapy was with Azathioprine in 55% (16/29), MMF 17% (5/29) and steroid alone 21% (6/29). Leucopaenia was recorded in N = 5. Of these, cyclophosphamide induction therapy was associated with two episodes of leucopaenia. Azathioprine therapy was associated with 2 cases. The 5th case identified was following Rituximab induction therapy. There were 10 documented cases of infection. Three patients died during the induction therapy. Induction of remission was achieved in 24/25 patients with cyclophosphamide and steroid therapy. Renal survival was 79% (23/29) at 3 months and 85% (22/26) at 1 year. Patient survival was 91% (29/32) at 3 months and 90% (26/29) at 1 year. Overall 50% (16/32) patients died during the period up period with a mean time to death of 25.2 months.
Conclusion
The results of the retrospective study show that induction therapy with cyclophosphamide was generally well tolerated with low rates of leucopenia and infections occurring during the maintenance phase. Mean survival of 25.2 months was comparable in this cohort of patients when compared to elderly patients (aged > 80) with CKD 5.