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Abstract: PO1936

Glucocorticoid Maintenance Therapy and Severe Infectious Complications in ANCA-Associated Vasculitis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Speer, Claudius, University of Heidelberg, Heidelberg, Germany
  • Nusshag, Christian, University of Heidelberg, Heidelberg, Germany
  • Kälble, Florian, University of Heidelberg, Heidelberg, Germany
  • Morath, Christian, University of Heidelberg, Heidelberg, Germany
  • Zeier, Martin G., University of Heidelberg, Heidelberg, Germany
  • Bergner, Raoul, Clinical Center Ludwigshafen, Ludwigshafen, Germany
  • Schaier, Matthias, University of Heidelberg, Heidelberg, Germany
Background

Although treatment and outcomes in anti-neutrophil cytoplasmic autoantibody associated vasculitis (AAV) have been improved over the last decades, intensified immunosuppressive burden is concurrently associated with life-threatening adverse effects which are the main cause of death during the first year after disease onset. Our study evaluates the impact of cyclophosphamide (CYC) induction dose and glucocorticoid maintenance dose and duration on patient outcomes with an emphasis on infectious complications.

Methods

A total of 130 AAV patients from two different German Vasculitis Centers diagnosed between 2004 and 2019 treated with CYC for induction therapy and glucocorticoids ± mycophenolate mofetil or azathioprine for maintenance therapy were included in this study. We evaluated the impact of CYC dose for induction therapy and glucocorticoid dose and treatment duration for maintenance therapy on time to relapse, kidney function, infectious complications, irreversible physical damage and mortality. Patients were separated into four groups: <3g versus ≥3g cumulative CYC dose and <7.5mg after 6 months versus ≥7.5mg glucocorticoids after 6 months.

Results

The baseline demographic and disease characteristics were comparable between groups. Cumulative CYC dose had no impact on relapse rate, kidney function, infectious complications or mortality. Patients receiving ≥7.5mg glucocorticoids after 6 months had an increased rate of infectious episodes per patient (0.6 vs. 1.7; p<0.001). Urinary tract infection (p=0.007), pneumonia (p=0.003) as well as opportunistic pneumonia (p=0.022) and sepsis (p=0.008) appeared more frequently. Especially pneumonia during the first 24 months after disease onset (hazard ratio, 3.0 [95% confidence interval (CI), 1.5−6.1]) led to more death by infections (p=0.034). Patients ≥65 years with ≥7.5mg glucocorticoids after 6 months were at particular risk for infectious complications. Glucocorticoid maintenance therapy had no impact on relapse rate or kidney function after the last follow-up.

Conclusion

An extended glucocorticoid maintenance therapy may induce severe infectious complications leading to an increased frequency of death by infection, has no effect on time to relapse and should therefore be critically revised throughout the aftercare of AAV patients.