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Patients of 75 years and over with ANCA-associated vasculitis have a lower relapse risk than younger patients: A multicentre cohort study.
Thietart, Sara; Beinse, Guillaume; Smets, Perrine; Karras, Alexandre; Philipponnet, Carole; Augusto, Jean-François; El Karoui, Khalil; Mesbah, Rafik; Titeca-Beauport, Dimitri; Hamidou, Mohamed; Carron, Pierre-Louis; Maurier, François; Sacre, Karim; Cohen, Pascal; Liozon, Eric; Blanchard-Delaunay, Claire; Kostianovsky, Alex; Pagnoux, Christian; Mouthon, Luc; Guillevin, Loïc; Terrier, Benjamin; Puéchal, Xavier.
Afiliación
  • Thietart S; National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • Beinse G; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
  • Smets P; Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université INSERM, Team Personalized Medicine, Pharmacogenomics and Therapeutic Optimization (MEPPOT), Paris, France.
  • Karras A; Department of Internal Medicine, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France.
  • Philipponnet C; Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
  • Augusto JF; Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France.
  • El Karoui K; Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire, Angers, France.
  • Mesbah R; Department of Nephrology and Renal transplantation, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Titeca-Beauport D; Department of Nephrology, Centre Hospitalier, Boulogne-sur-Mer, France.
  • Hamidou M; Department of Nephrology, Amiens University Medical Center, Amiens, France.
  • Carron PL; Department of Internal Medicine, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France.
  • Maurier F; Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France.
  • Sacre K; Department of Internal Medicine and Immunology, Groupe Hospitalier UNEOS, Metz-Vantoux, France.
  • Cohen P; Department of Internal Medicine, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, INSERM U1149, Paris, France.
  • Liozon E; National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • Blanchard-Delaunay C; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
  • Kostianovsky A; Department of Internal Medicine and Clinical Immunology, Dupuytren University Hospital, Limoges, France.
  • Pagnoux C; Department of Internal Medicine, Centre Hospitalier, Niort, France.
  • Mouthon L; National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • Guillevin L; National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • Terrier B; National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • Puéchal X; APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France.
J Intern Med ; 291(3): 350-363, 2022 03.
Article en En | MEDLINE | ID: mdl-34755398
BACKGROUND: Little is known about antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in older patients. We aim to study relapse risk of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) in patients diagnosed after 75 years and compare it with those of patients aged 65-75 years. METHODS: Data from AAV patients aged ≥65 years were extracted from the French Vasculitis Study Group (FVSG) database and from a call for observation to FVSG members. Cox and Fine-Gray models were used to assess relapse risk, taking death into account either as a censoring or a competing event, respectively. RESULTS: The analysis included 219 patients aged ≥75 years (median 79) and 80 patients aged 65-75 years (median 70), of those 155 had GPA (52%), 136 MPA (45%), with 95 (32%) anti-proteinase 3 positivity and 179 (61%) anti-myeloperoxidase. Patients aged ≥75 years had a lower relapse risk in multivariate analysis (cause-specific hazards ratio [CSHR] 0.54, 95% CI [0.33-0.89], p = 0.016, Cox model; subdistribution hazard ratio [SHR] 0.46, 95% CI [0.29-0.74], p = 0.001, Fine-Gray model) after taking into account vasculitis type. Patients aged ≥75 years had a lower probability of being treated for remission maintenance with a combination of glucocorticoids and immunosuppressants (vs. glucocorticoids alone, HR 0.28, 95% CI [0.11-0.68], p = 0.005) after adjusting to Five Factor Score, although relapse-free survival was significantly longer when receiving such combination (CSHR 0.40, 95% [CI 0.24-0.67], p < 0.001). CONCLUSIONS: AAV patients ≥75 years have a lower relapse risk than patients aged 65-75 years despite a lower probability of having received maintenance therapy with a combination of glucocorticoids and immunosuppressants, but they still benefit from such treatment regimen.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Granulomatosis con Poliangitis / Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2022 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Granulomatosis con Poliangitis / Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: J Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2022 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido