Abstract: FR-PO647
Impact of Immunosuppressive Therapy on Vascular and Vasogenic Alterations of the Central Nervous System in Patients With ANCA-Associated Vasculitis With Renal Involvement
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials
Authors
- Lubas, Arkadiusz, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
- Maliborski, Artur, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
- Grzywacz, Anna, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
- Splocharski, Grzegorz, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
- Niemczyk, Stanislaw, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
Background
The data concerning the prevalence of CNS vasculitis in patients with ANCA-associated vasculitis (AAV) with renal involvement is limited. Moreover, the efficacy of systemic immunosuppressive therapy (IS) on CNS alterations in this population of patients was not clearly evidenced. This study aimed to prospectively estimate the occurrence of CNS vascular alterations and the influence of 1-year IS in patients with AAV with renal involvement.
Methods
Patients with acute onset of AAV with renal involvement qualified for the intensive IS were prospectively included in the study. As the treatment, an induction and a maintenance IS were provided. BVAS, creatinine, MPO-ANCA, PR3-ANCA, and non-contrast brain MRI angiography were estimated initially and after 12 months. Vascular alterations in the form of alternating narrowing and dilatation (aND) in secondary and tertiary cerebral artery branches (CAB) were investigated. Moreover, the number of focal ischemic white matter lesions (WML) was estimated. McNamara test was used to compare dependent categorical variables and Wilcoxon’s test for continuous dependent variables comparison.
Results
In total, 17 patients who completed both brain MRI assessments were included in the study.
Initially, aND was found in 12/17 (70.5%) patients, but after treatment, these alterations were investigated in 7/12 (41.2%) participants (p=0.074). In the secondary CAB IS resulted in 50% decrease of aND (10/17 vs. 5/17; p=0.074). Moreover, the reduction of aND in tertiary CAB was significant (9/17 (52.9%) vs. 3/17 (17.6%); p=0.041). In all participants, WML were detected before and after the IS, and the IS did not change the number of these lesions. A significant decrease in BVAS (7.76 ±3.49 vs. 0.65 ±0.86; p<0.001) and MPO-ANCA (60.2 ±46.5 vs. 24.5 ±36.0 p<0.001) after IS was investigated. The decrease of creatinine and PR3-ANCA was not important.
Conclusion
The occurrence of brain vasculitis lesions is frequent in patients with a flare of ANCA-associated vasculitis with renal involvement. Immunosuppressive treatment decreases CNS vascular alterations, which corresponds with the decrease of MPO-ANCA and clinical activity of the disease.
Funding
- Government Support – Non-U.S.