Abstract: SA-PO697
Efficacy and Safety of Remission Induction Regimens in Elderly Patients With ANCA-Associated Glomerulonephritis
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - III
November 05, 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
- Xu, Lillian, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Aqeel, Faten Faisal, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Wen, Yumeng, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Geetha, Duvuru, Johns Hopkins Medicine, Baltimore, Maryland, United States
Background
Induction regimens using either cyclophosphamide (CYC) or rituximab (RTX) have demonstrated comparable efficacy and adverse event rates in a randomized trial of patients with mean age of 54 years. However, data is sparse on outcomes of older patients with ANCA-associated glomerulonephritis (ANCA GN) receiving such therapies. This study aimed to compare outcomes in elderly ANCA GN patients based on induction regimen (CYC vs. RTX vs. CYC+RTX).
Methods
Patients, age 60 and above, diagnosed with ANCA GN were retrospectively identified. Baseline characteristics and outcomes across several clinical parameters were recorded and compared between CYC, RTX, and CYC+RTX groups for significance using Kruskal-Wallis test, Chi-squared test, and multivariate logistic regression as appropriate.
Results
Among 75 patients with ANCA GN with a mean (SD) age of 70 (6) years at diagnosis, there were significant differences in age at diagnosis (p=0.018), Caucasian race (p=0.01), entry eGFR (p=0.00009), dialysis at entry (p=0.009), and use of plasmapheresis (p=0.001) between the CYC (n=25), RTX (n=38), and CYC+RTX (n=12) groups. There were no significant differences between the three groups in prednisone dose at 6 months (p=0.06), infections requiring antibiotics (p=0.57), disease remission (p=0.37), and ESKD at 1 year (p=0.999). There was a significant difference in bone marrow suppression (p=0.002) between the CYC (28%), RTX (2.6%), and CYC+RTX (41.6%) groups. Moreover, after adjustment for age at diagnosis, entry eGFR, and prednisone dose at 6 months, use of RTX only was associated with reduced bone marrow suppression (aOR = 0.08, 95% CI = 0-0.6) [Table].
Conclusion
CYC, RTX, and CYC+RTX are equally effective in remission induction in elderly patients with ANCA GN. Use of RTX only was associated with a lower risk of bone marrow suppression compared to CYC only. More information is needed on the comparative safety of induction therapy strategies in elderly ANCA GN patients.
| Outcome | |||
| Treatment group | CYC | RTX | CYC+RTX |
| Infection (OR) | Reference | 0.47 (0.14-1.54) | 0.94 (0.21-4.07) |
| Bone marrow suppression (OR) | Reference | 0.08 (0-0.6) | 1.63 (0.33-8.04) |
| Prednisone dose at 6 months (coefficient) | Reference | -2.87 (-5.92-0.17) | 0.51 (-3.53-4.56) |
| GFR at 12 months (coefficient) | Reference | -1.16 (-8.82-6.5) | -4.12 (-14.38-6.14) |
| ESKD at 12 months (OR) | Reference | 7.02 (0.57-162.63) | 0.53 (0.02-7.05) |
Funding
- Clinical Revenue Support