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Abstract: SA-PO644

Benefit or Burden: A Systematic Review and Meta-Analysis of Treatment Outcomes of ANCA-Associated Vasculitis in Patients Older Than 75 Years

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Morris, Adam, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
  • Elsayed, Mohamed, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
  • Brady, Mark, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
  • Ponnusamy, Arvind, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
  • Dhaygude, Ajay Prabhakar, Royal Preston Hospital, Lancashire NHS Foundation Trust, Preston, United Kingdom
Background

Despite a peak incidence of 64-75 years, the benefit of treating ANCA-associated vasculitis (AAV) in older patients remains unclear with most published studies defining elderly as >65 years. This study aims to determine outcomes of induction immunosuppression in patients aged >75 years.

Methods

A cohort aged >75 years with biopsy proven AAV was constructed from a single centre between 2006–2016. Follow up was to two years or death. Analysis included multivariate Cox regression to compare mortality and ESRD based on induction immunosuppression therapy. A systematic review of outcome studies was subsequently undertaken amongst this patient group through Pubmed, Cochrane and Embase databases from inception until 13/09/18.

Results

From 145 patients, 59 were >75 years, of which 51 had completed data. Mean age was 78.9+2.7, 54.9% were male and mean modified Charlson comorbidity index was 1+1.3. 76% (n=39) received induction therapy. The systematic review identified 1943 citations. Four studies were eligible for inclusion, yielding a combined total of 274 patients inclusive of our cohort. The aggregated one year mortality irrespective of treatment was 36% (CI 27–47%). Within our cohort, induction immunosuppression therapy was associated with a lower two-year mortality risk, although not statistically significant [HR 0.75 (95% CI 0.23–2.49)]. However, the pooled HR by meta-analysis revealed a significant risk reduction for death [HR 0.44 (95% CI 0.25–0.76), I2=0%]. Treated patients had a lower pooled rate of ESRD, but was not statistically significant [HR 0.76 (95% CI 0.37–1.59)].

Conclusion

This meta-analysis suggests that patients >75 years with AAV do benefit from induction immunosuppression with a significant survival benefit. Age should not be a limiting factor when considering treatment. Further trials are required to better evaluate renal outcomes amongst this age group.

Forest plot of mortality risk in patients with AAV >75 years based on the use of induction immunosuppression