Advanced

Long term azathioprine maintenance therapy in ANCA-associated vasculitis : combined results of long-term follow-up data

de Joode, Anoek A.E.; Sanders, Jan Stephan F.; Puéchal, Xavier; Guillevin, Loic P.; Hiemstra, Thomas F.; Flossmann, Oliver; Rasmussen, Nils; Westman, Kerstin LU ; Jayne, David R. and Stegeman, Coen A. (2017) In Rheumatology1999-01-01+01:00 56(11). p.1894-1901
Abstract

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... (More)

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.

Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up.

(Less)
Please use this url to cite or link to this publication:
author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ANCA, azathioprine, EUVAS, FVSG, granulomatosis with polyangiitis, long-term follow-up, maintenance, PR3, vasculitis
in
Rheumatology1999-01-01+01:00
volume
56
issue
11
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:85032814074
ISSN
1462-0332
DOI
10.1093/rheumatology/kex281
language
English
LU publication?
no
id
800f1378-961e-4eaa-9ea5-6b5a191ffcc1
date added to LUP
2017-11-22 13:48:37
date last changed
2018-01-07 12:26:30
@article{800f1378-961e-4eaa-9ea5-6b5a191ffcc1,
  abstract     = {<p>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 &gt; 48 months. Primary outcome was relapse-free survival at 60 months.</p><p>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 &gt;12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance &gt;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).</p><p>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.</p><p>Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up.</p>},
  author       = {de Joode, Anoek A.E. and Sanders, Jan Stephan F. and Puéchal, Xavier and Guillevin, Loic P. and Hiemstra, Thomas F. and Flossmann, Oliver and Rasmussen, Nils and Westman, Kerstin and Jayne, David R. and Stegeman, Coen A.},
  issn         = {1462-0332},
  keyword      = {ANCA,azathioprine,EUVAS,FVSG,granulomatosis with polyangiitis,long-term follow-up,maintenance,PR3,vasculitis},
  language     = {eng},
  month        = {11},
  number       = {11},
  pages        = {1894--1901},
  publisher    = {Oxford University Press},
  series       = {Rheumatology1999-01-01+01:00},
  title        = {Long term azathioprine maintenance therapy in ANCA-associated vasculitis : combined results of long-term follow-up data},
  url          = {http://dx.doi.org/10.1093/rheumatology/kex281},
  volume       = {56},
  year         = {2017},
}