ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: SA-PO660

Maintenance Treatment in ANCA-Associated Vasculitis (AAV): Definition, Clinical Outcomes, and Significant Burden of Disease in Real-World Clinical Practice

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Rutherford, Peter A., Vifor Pharma, Glattbrugg, Switzerland
  • Goette, Dieter Karl, Vifor Pharma, Glattbrugg, Switzerland
Background

After remission induction AAV is a relapsing remitting long term condition and patients are at risk of organ damage from both active AAV and therapy in particular glucocorticoids (GC). This maintenance phase of AAV is critical for good long term outcomes. This retrospective study examined the definition of maintenance, therapies and clinical outcomes in AAV patients in routine clinical practice.

Methods

AAV patients from 4 European countries (310 physicians) who completed induction therapy for organ/life threatening AAV and initiated maintenance therapy between 2014-16 were studied. Data were collected from when maintenance was determined to begin by the physician and at 6, 12, 18 and 36 months.

Results

929 patients were studied - 51% had granulomatosis with polyangiitis, mean age 54 years with 54% male. 49% were incident AAV patients and 51% relapsing. Physicians defined maintenance beginning at mean of 5.6 months from induction start on basis of fixed time point 38%, starting of new drug for maintenance 27%, reaching full remission 26% and no specific criteria 9%. At this time 45% were in full remission vs 49% in partial and 6% refractory. Over 36 months after maintenance was defined, 84% were still in remission but 10% had major relapse requiring re-induction and left follow up, 6% died (2/3 at time of relapse). There is variation in maintenance drug regimes, initially in 929 patients GC 62%, Azathioprine 37%, Rituximab 19% and MMF 18%. At 36 months, 9% of AAV patients were receiving renal replacement therapy and CKD was reported as a comorbidity in 17% vs 7% at start of remission induction therapy.

Conclusion

Maintenance therapy in AAV is variably defined but typically 6 months after start of remission induction . Relapse severity varies and is still a problem and many patients require ongoing GC therapy to maintain remission. Infections and renal complications are an unmet need in AAV maintenance. There is a need for new targeted therapies in AAV to improve clinical outcomes in the maintenance phase.

 6 months12 months18 months36 months
Remission n817789777742
Total relapse %/ major %12/4610/536/517/66
GC/Azathioprine/Rituximab/ MMF %59/36/20/1949/31/17/1840/28/15/1633/23/13/12
GC dose > 7.5mg %59413029
At least 1 infection %43342826

Funding

  • Commercial Support –