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Abstract: PO1933

Renal Disease During Maintenance Treatment in ANCA-Associated Vasculitis (AAV) Remains a Problem and Glucocorticoid Use Is High

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

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

AAV is a relapsing remitting long term condition and patients are at risk of organ damage from active AAV and therapy in particular glucocorticoids (GC). The remission maintenance phase of AAV is critical for good long term renal outcomes. This retrospective study examined the pattern of renal disease during the maintenance phase in AAV patients managed in routine clinical practice

Methods

1478 AAV patients managed by 493 EU physicians (61% Nephrologists) who completed induction therapy for organ/life threatening AAV and initiated therapy between 2014-16 were studied. Data were collected from when maintenance was determined to begin by the physician and then after 6, 12, 18 and 36 months

Results

49% had GPA; mean age 54.2 years and 56% male. 49% had incident AAV and 51% were studied from relapse. 70% received cyclophosphamide/GC and 30% received rituximab/GC with 28% plasma exchange. Physicians defined time of start of maintenance as mean of 5.7 months from diagnosis. Over 36 months from maintenance start 38% patients had relapse (26% 1, 8% 2, 3% 3 and 1% 4). Only 22% had no comorbidity at diagnosis, hypertension and renal impairment were common. eGFR CKD stage changed over tme - stage 5 (8% to 11%), stage 4 (12 to 8%), stage 3 (43 to 37%) and stage2/1 (38 to 46%) – mean at 36 months of 53.3 ml/min. Hypertension and renal impairment were frequent comorbidities and renal related AEs were often reported. Many patients stayed on GCs and renal impairment and hypertension as well as active/chronic vasculitis activity were more frequent in patients remaining on GCs throughout maintenance. Renal function worsened in 24% patients and 46% were still receiving steroids vs 35% and 37% of those with improved or unchanged renal function (p< 0.05)

Conclusion

This study demonstrates relapse remains a problem iin AAV and many patients still receive long term GCs. Worsening renal disease is a challenge and associates with higher GC exposure suggesting ongoing renal inflammation and/or chronic damage. New therapeutic approaches are needed to improve renal outcomes

Funding

  • Commercial Support