1. Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data
- Author
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Kerstin Westman, Thomas F. Hiemstra, Jan-Stephan F. Sanders, Xavier Puéchal, Anoek A. E. de Joode, David Jayne, Coen A. Stegeman, Loïc Guillevin, Oliver Flossmann, Nils Rasmussen, Hiemstra, Thomas [0000-0002-2115-8689], Jayne, David [0000-0002-1712-0637], Apollo - University of Cambridge Repository, Groningen Kidney Center (GKC), Translational Immunology Groningen (TRIGR), and Groningen Institute for Organ Transplantation (GIOT)
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,030232 urology & nephrology ,Microscopic Polyangiitis ,Azathioprine ,long-term follow-up ,RELAPSE ,vasculitis ,0302 clinical medicine ,Maintenance therapy ,Interquartile range ,Recurrence ,CYCLOPHOSPHAMIDE ,Pharmacology (medical) ,Neoadjuvant therapy ,FVSG ,ANCA ,INDUCTION ,Middle Aged ,Female ,Kidney Diseases ,Vasculitis ,Granulomatosis with polyangiitis ,Microscopic polyangiitis ,ANTIBODY-ASSOCIATED VASCULITIS ,Immunosuppressive Agents ,medicine.drug ,Systemic vasculitis ,Adult ,medicine.medical_specialty ,Myeloblastin ,SYSTEMIC VASCULITIS ,Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ,EUVAS ,Disease-Free Survival ,maintenance ,Antibodies, Antineutrophil Cytoplasmic ,Maintenance Chemotherapy ,03 medical and health sciences ,Young Adult ,WEGENERS-GRANULOMATOSIS ,RENAL INVOLVEMENT ,Rheumatology ,Internal medicine ,medicine ,Humans ,RITUXIMAB ,Aged ,Peroxidase ,030203 arthritis & rheumatology ,granulomatosis with polyangiitis ,business.industry ,REMISSION ,medicine.disease ,PR3 ,RANDOMIZED-TRIAL ,Surgery ,business ,Follow-Up Studies - Abstract
Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up.Methods: Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months.Results: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative).Conclusion: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
- Published
- 2018
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