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Abstract: PO1937

Country Differences Exist in the Treatment of ANCA-Associated Vasculitis (AAV), but High-Dose and Prolonged Glucocorticoid Use Is Observed Across Europe

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

European AAV guidelines recommend remission induction therapy with combination of high dose glucocorticoids (GC) and rituximab (RTX) or cyclophosphamide (CYC) and maintenance therapy with either RTX or azathioprine (AZA). This retrospective study examined the pattern of prescribing, including the use of GCs, across Europe in AAV patients managed in routine clinical practice

Methods

1478 AAV patients managed by 493 physicians in France, Germany, Italy, Spain and UK who completed induction therapy for organ or life threatening AAV (49% incident and 51% relapsing) and initiated maintenance therapy between 2014-16 were studied. Data were collected at the time maintenance was determined to begin by the physician and then after 6, 12, 18 and 36 months.

Results

AAV type varied with more GPA in Germany (52%) and UK (56%) compared to France (47%), Italy (47%) and Spain (40%). Proportion of patients with severe progressive disease varied - 41% Italy to 48% France. Induction therapy varied with lowest use of IV GC and rituximab (RTX) and highest cyclophosphamide (CYC) use in the UK. Maintenance was defined by clinicians as approximately 6 months following treatment start and GCs were used similarly across all countries with less RTX and less GC used in UK and more AZA in Germany and UK. At 36 months prescribing patterns were similar and a variable proportion of patients (13% Germany to 30% France) stopped therapy but with approximately 25% patients not in full remission

Conclusion

AAV treatment prescribing patterns vary across Europe particularly RTX, driven by economic as well as case mix differences. GC use is high across all countries with high GC use (including IV at induction) and prolonged use over 36 months being common. Sustained remission rates could be improved and there is need for more targeted therapies to reduce reliance on GCs

AAV prescribing (*p<0.05 vs respective highest/lowest country)

Funding

  • Commercial Support