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Abstract: SA-PO409

10 Year, Age-Stratified Outcomes of ANCA Associated Vasculitis Treated with IV Cyclophosphamide

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Leonard, Hugh, St Helier Hospital, London, United Kingdom
  • Sood, Bhrigu Raj, South West Thames Renal Unit, Carshalton, Surrey, United Kingdom
  • Condon, Marie B., St. Helier Hospital, Surrey, United Kingdom
  • Makanjuola, David, St. Helier Hospital, Surrey, United Kingdom
  • Harris, Fiona E., Epsom and St Helier NHS Trust, Surrey, United Kingdom
Background

ANCA associated vasculitis (AAV) is a multisystem disease with morbidity and mortality associated with disease and treatment. The aim is to induce and maintain remission, and minimise side effects. Studies suggest high mortality among treated elderly patients and concerns have been raised about under-treatment in younger patients.
We use IV cyclophosphamide (CyP) for induction (dose adjusted for age, weight and eGFR). We present mortality and renal outcomes in patients treated with IV CyP for AAV followed by maintenance therapy with Azathioprine or Mycophenolate.

Methods

Data was collected from medical records of patients treated with IV CyP from Jan 2007 to Jan 2017 with follow up until May 2018.

Results

197 patients met the inclusion criteria: 54% men, 89% Caucasian, median age of 70(18-89) and 45% had PR3 antibodies. 41% were dialysis-dependent at diagnosis. IV steroids were used in 58% and Plasma Exchange in 32%. Induction with CyP was not completed in 4 patients due to intolerance/infection. Rituximab was given to 3 who failed to achieve remission.
Median follow up was 60 months(10-133). 44(22%) patients died due to: infection(9), vasculitis(3), malignancy(6) and other(26). 5 died during induction: 2 of vasculitis and 3 of unknown causes. 42 had at least one relapse. Of the 80 who were dialysis-dependent at diagnosis, 52 recovered renal function. Age(p<0.01) and end-stage renal failure(adjusted OR 8.1, p<0.01) were associated with mortality. 27 new cancers were detected during follow up.

Conclusion

We report on a single-centre cohort followed up for up to 10 years with a large number of elderly patients. The oldest age group had longest time to relapse, but also the highest unadjusted mortality and highest frequency of advanced CKD. There was a trend towards more relapses among younger patients. Although the dose of CyP is stratified according to age and renal function, this study highlights the possibility of under-treatment in younger patients.

Table 1 (Outcomes according to age)
Age Group<50 years50-65 years65-80 years>80 years
Number (% male)22 (59% male)51 (58% male)97 (55% male)27 (37% male)
Relapse (%)9 (41%)11 (22%)17 (18%)5 (19%)
Median time to relapse in months21313033
Died during follow up (%). p<0.0107 (14%)28 (29%)9 (33%)
Median time to death in monthsNA363623
CKD stages 4-5 (%). p<0.013 (14%)19 (37%)47 (48%)17 (63%)