Abstract: SA-OR027
Long-Term Follow-Up of a Glucocorticoid-Minimising Regimen for Remission Induction in ANCA Vasculitis (AAV)
Session Information
- ANCA It Is
November 09, 2019 | Location: 207, Walter E. Washington Convention Center
Abstract Time: 05:42 PM - 05:54 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- McAdoo, Stephen Paul, Imperial College London, London, United Kingdom
- Pepper, Ruth, Royal Free Hospital, London, United Kingdom
- Hamour, Sally, UCL, Royal Free Campus, London, United Kingdom
- Burns, Aine, Centre for Nephrology Royal Free NHS Trust, London, LONDON, United Kingdom
- Little, Mark Alan, Trinity College Dublin, Dublin, Ireland
- Cairns, Tom, Imperial College Healthcare, London, United Kingdom
- Salama, Alan D., University College London, London, United Kingdom
- Pusey, Charles D., Imperial College London, London, United Kingdom
Background
Glucocorticoids (GC), though a mainstay of treatment for AAV, have significant adverse effects. We previously reported successful short-term outcomes using a GC-sparing treatment regimen. Here, we report long term outcomes in an extended cohort of patients treated with this protocol.
Methods
Patients were treated at 2 centres with rituximab (RTX) 2x1g, low-dose iv cyclophosphamide (CYC), and a short course of oral GC of <2 weeks duration, followed by maintenance azathioprine/MMF. Data reported as median ± IQR.
Results
58 patients with new (84%) or relapsing (16%) AAV are included, with average follow up of 37 (23-46) months. 65% were MPO-ANCA+ve, 29% PR3-ANCA, 5% ANCA negative. Initial BVAS, CRP and creatinine were 14 (12-19), 46( 11-90) mg/L, and 176 (131-270) µmol/L, respectively. 90% had biopsy-proven renal involvement. The median dose of GC during induction was 960 (781-1276) mg. 5 patients (9%) required re-introduction of GC during the first 3 months for active disease; all patients subsequently achieved remission by 3 months, which was sustained in 91% at month 12. At 3 years, 96% were alive, 95% with independent renal function.19% had relapsed, however the majority (80%) remained free of GC (Figure 1A). There were no significant differences in renal or relapse-free surival compared to a previous cohort treated with a comparable RTX+CYC regimen, along with standard steroid dosing (Figure 1B).
Conclusion
Rapid GC withdrawal was safe and effective in the majority of cases following induction with RTX+CYC. Long-term patient, renal and relapse-free survival are comparable to published cohorts treated with standard GC. A small proportion required early re-introduction of GC, such that careful monitoring is required, though GC avoidance was feasible in the majority. Controlled studies are warranted to compare the efficacy of this regimen to current standards of care.