Clinical aspects
A past medical history of autoimmune disease predicts a future with fewer relapses in patients with ANCA-associated vasculitis
S. Lionaki1, S. Marinaki2, S. Fragkioudaki3, I. Bellos4, E. Kalaitzakis5, P. Kalogeropoulos6, G. Liapis7, A.G. Tzioufas8, J.N. Boletis9
- Department of Nephrology, Attikon Hospital, National and Kapodistrian University of Athens, Greece. sophial@med.uoa.gr
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Pathology, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Pathophysiology, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
- Department of Nephrology and Transplantation Unit, Laiko Hospital, National and Kapodistrian University of Athens, Greece.
CER15128
2022 Vol.40, N°4
PI 0741, PF 0750
Clinical aspects
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PMID: 35522540 [PubMed]
Received: 02/09/2021
Accepted : 29/11/2021
In Press: 04/05/2022
Published: 04/05/2022
Abstract
OBJECTIVES:
To explore the frequency and impact of an autoimmune disease past-medical history (PMH) in the clinical picture and outcomes of patients with antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV).
METHODS:
This was a retrospective study of patients with biopsy-proven AAV, >16 years old, with detailed information about their PMH. Outcomes of interest included remission, treatment resistance, relapse, end-stage kidney disease (ESKD), and death.
RESULTS:
206 patients with biopsy-proven AAV and available information regarding their PMH were studied. 63(30.6%) of them had a history of autoimmune disease prior to AAV diagnosis. The mean age overall was 54.1 years. One hundred and five patients (51%) were positive for PR3-ANCA, 101 (49%) for MPO-ANCA. Granulomatosis with polyangiitis was diagnosed in 79 (38.3%), microscopic polyangiitis in 97 (47.1%) and renal-limited vasculitis in 30 (14.6%) individuals. Remission rate was similar among patients with and without a PMH of autoimmune disease. Time-to-event analysis indicated that the relapse-free survival was significantly longer in patients with PMH of autoimmune disease (148.2 vs. 61.9 months, p-value <0.001). After adjusting for covariates, autoimmune disease history was associated with significantly lower risk of relapse (HR: 0.33, 95% CI: 0.15-0.72), which remained significant in males, patients ≥60 years old and those with C/PR3-ANCA, kidney and lung involvement.
CONCLUSIONS:
Patients with a PMH of autoimmune disease, prior to AAV diagnosis, experienced significantly fewer relapses after achievement of remission, compared to patients without such a history, underlining the importance of individualisation of maintenance immunosuppressive therapy, given the different aetiopathogenetic settings the disease was developed.
