Relapse Remains Common in Vasculitis

While the overall risk of end-stage renal disease (ESRD) or death has decreased over the past 25 years among renal disease patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), the risk of relapse these patients face has not changed in that time, according to a new study.

Researchers from institutions such as Temple University School of Medicine and the University of Pennsylvania examined temporal changes over 25 years in long-term clinical outcomes, including the impact of renal function at diagnosis, which the authors note is a potential marker of time to disease detection. The investigators also evaluated the duration of cyclophosphamide use in AAV patients with renal involvement.

Overall, the researchers included data from 544 patients from the Glomerular Disease Collaborative Network AAV registry in their analysis, noting a decreasing 5-year risk of ESRD or death over time. After adjusting for baseline characteristics, however, the team found that the risk of relapse was similar across the time periods studied, with serum creatinine at baseline representing the only significant predictor of an increased risk of ESRD or death, according to the authors.

Overall, 160 deaths occurred, equating to an incidence rate of 7 deaths per 100 patient years. The 1-year survival rate was 91%, while 5-year survival was 72%, with survival improving considerably over time. In total, 181 patients, or 33%, developed ESRD over the course of the study. After 1 year, 20% of patients had developed ESRD, with that number reaching 65% after 5 years. At these intervals, 5% and 23% had died of causes other than ESRD, respectively. After adjustments, renal survival significantly improved across the duration of the study, according to the authors, who note that the relapse rate was 13.9 events per 100 patient years.

Over 25 years, the risk of ESRD or death has decreased among patients with renal disease secondary to AAV, “but the risk of relapse has not changed,” the authors concluded. “A higher serum creatinine at diagnosis is associated with a higher risk of ESRD or death, suggesting that earlier disease detection is potentially an important measure to improve outcomes in AAV.”

—Mark McGraw

Reference

Rhee R, Hogan S, et al. Trends in long-term outcomes among patients with ANCA-associated vasculitis with renal disease. Arthritis & Rheumatology. 2016.