Kidney Week

Abstract: SA-PO659

Glucocorticoids for Remission Induction in Incident ANCA-Associated Vasculitis (AAV) Patients in Real-World Practice: High Exposure and Temporal Relationship to Adverse Events

Session Information

• Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Rutherford, Peter A., Vifor Pharma, Glattbrugg, Switzerland

Peter A. Rutherford,

• Goette, Dieter Karl, Vifor Pharma, Glattbrugg, Switzerland

Dieter Karl Goette,

Background

Rapid induction of remission in AAV is desirable and typically includes high dose glucocorticoids (GC). While achieving remission is critical, patients are also at risk from GC-related adverse events (AEs) leading to long term organ damage as well as acute morbidity and mortality. This study examined GC prescribing, AAV response and AEs in incident AAV patients managed in routine clinical practice

Methods

929 incident AAV patients from 4 European countries (399 physicians) were diagnosed between 2014-17 and data collected at baseline, 1, 3, 6 and 12 months following induction therapy start were reviewed

Results

54% of patients had granulomatosis with polyangiitis, and 46% had microscopic polyangiitis; mean age was 56.82 years (SD 14.2) with 53.7% male. Physicians reported 12% patients as mild/localized, 54% as moderate systemic and 34% as severe life threatening vasculitis. 83% of patients received GCs – 49% IV followed by oral, 17% oral only and 17% IV only. 43% used cyclophosphamide and GC, 13% rituximab and GC, 10% only GC with remainder using other regimes. As BVAS was not used, full clinical response was assessed as no vasculitis activity and GC taper on track. Most patients remained on GCs over 12 months, AAV response was incomplete and AEs were common especially in first 3 months when GC dose highest. Dose change practice varied and more UK patients had GC reductions at 3 (55%) and 6 months (46%) compared to other countries. At 12 months, of the 61% patients still receiving GCs, 34% were taking < 5mg, 56% 5-10mg, 9% 10-20mg and 2% > 20mg. 67% had no AAV activity, 17% local disease only, 11% mild/moderate systemic disease and 6% moderate/severe systemic disease

Conclusion

Most incident AAV patients receive high dose GCs, commonly IV, and most remain on GCs over 12 months. AEs and infections are common especially in the first months when GC dose is high. Remission is variable and only a minority of patients at 12 months have full control of AAV without steroids. New treatments are needed to address this unmet medical need

Funding

• Commercial Support –