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Abstract: PO1627

Maintenance of Remission and Risk for Relapse in Myeloperoxidase Positive Antineutrophil Cytoplasmic Antibody-Associated Vasculitis with Kidney Involvement

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Casal Moura, Marta Isabel Rodrigues, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Tehranian, Shahrzad, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Bobart, Shane A., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Greene, Eddie L., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Specks, Ulrich, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background

Optimal time of remission-maintenance therapy in patients with MPO-ANCA associated vasculitis (MPO-AAV) is not established. Defining clinical and laboratory parameters to guide safe withdrawal of maintenance immunosuppression is required in order to mitigate the risk of relapse.

Methods

A retrospective cohort study of all patients followed at the Mayo Clinic with MPO-AAV (MPA and GPA) and kidney involvement. Relapse rate, correlation with MPO-ANCA status and remission-maintenance strategy were characterized.

Results

We analyzed 159 MPO-ANCA positive patients with active kidney involvement. A total of 66 (41.5%) patients had at least 1 relapse. MPO-ANCA patients who became and remained seronegative did not relapse (HR 0.032, [95%CI, 0.001-0.970], p=0.048). MPO-ANCA reappearance after seronegative conversion was associated with increased relapse risk at 24 months (HR 3.651, [95%CI, 1.114-11.966], p=0.012). Immunosuppression was withdrawn in 80 (50.3%) and this was predicted by persistent MPO-ANCA seronegative conversion (OR 3.028, [95%CI, 1.262 – 7.268], p=0.013). In patients who withdrew remission-maintenance therapy, 32 (40.0%) relapsed (in comparison with 34 relapses [43.0%] in those who maintained immunosuppression, p=0.697). ENT involvement (OR 6.095 [95%CI, 1.280 – 29.010], p=0.023) and MPO-ANCA reappearance (OR 9.248, [95%CI, 3.126 – 27.361], p<0.0001), were independent predictive factors for relapse after withdrawal.

Conclusion

Our results suggest that patients who seroconverted and remain MPO-ANCA negative are at lower risk of relapse: remission-maintenance treatment might be withdrawn without an additional risk of relapse. MPO-ANCA reappearance after seronegative conversion is a risk factor for relapse at 24 months. Serial MPO-ANCA determinations are useful to guide clinical decisions on remission-maintenance treatment strategies.