ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: SA-PO697

Efficacy and Safety of Remission Induction Regimens in Elderly Patients With ANCA-Associated Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials


  • 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

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).


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.


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].


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.

Treatment groupCYCRTXCYC+RTX
Infection (OR)Reference0.47 (0.14-1.54)0.94 (0.21-4.07)
Bone marrow suppression (OR)Reference0.08 (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)Reference7.02 (0.57-162.63)0.53 (0.02-7.05)


  • Clinical Revenue Support