Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract

Gendreau, Ségolène; Porcher, Raphaël; Thoreau, Benjamin; Paule, Romain; Maurier, F.; Goulenok, Tiphaine; Frumholtz, L.; Bernigaud, C.; Ingen‐Housz‐Oro, Saskia; Mékinian, A.; Audemard-Verger, Alexandra; Gaillet, Antoine; Pérard, L.; Samson, M.; Sonneville, Romain; Arlet, Jean‐Benoît; Mirouse, Adrien; Kahn, Jean‐Emmanuel; Charpentier, Julien; Hachulla, É.; Hummel, Aurélie; Pires, Thomas A.; Carron, Pierre-Louis; Durel, Cécile‐Audrey; Jourde, Wendy; Puéchal, Xavier; Lega, Jean‐Christophe; Sarrot-Reynauld, F.; Tieulié, N.; Diot, Élisabeth; Guillevin, Loı̈c; Terrier, Benjamin

doi:10.1016/j.semarthrit.2021.03.002

Cited by 15 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As for other pathologies that require long-term therapy with GCs, the extensive use of systemic antibacterial drugs is plausibly due to the increased susceptibility to infections in immunosuppressed patients, as largely corroborated by the literature [ 35 – 37 ]. Prescriptions for the treatment of gastric acidity were observed in over 74% in GPA and 84% of MPA patients, and such elevated percentages might be feasibly explained by the protracted exposure to GCs [ 38 ], as well as by systemic vasculitis itself, often characterized by gastrointestinal symptoms [ 39 , 40 ] and gut microbiota alterations [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy

Degli Esposti,

Dovizio,

Perrone

et al. 2023

Adv Ther

View full text Add to dashboard Cite

Introduction Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases triggering inflammation of small vessels. This real-world analysis was focused on the most common AAV forms, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), to describe patients’ demographic and clinical characteristics, therapeutic management, disease progression, and the related economic burden. Methods A retrospective analysis was conducted on administrative databases of a representative sample of Italian healthcare entities, covering approximately 12 million residents. Between January 2010 and December 2020, adult GPA patients were identified by payment waiver code or hospitalization discharge diagnosis, and MPA patients by payment waiver code with or without hospitalization discharge diagnosis. Clinical outcomes were evaluated through AAV-related hospitalizations, renal failure onset, and mortality. Economic analysis included healthcare resource utilization deriving from drugs, hospitalizations, and outpatient specialist services. The related mean direct costs year/patient were also calculated in patients stratified by presence/absence of glucocorticoid therapy and type of inclusion criterion (hospitalization/payment waiver code). Results Overall, 859 AAV patients were divided into GPA ( n = 713; 83%) and MPA ( n = 146; 17%) cohorts. Outcome indicators highlighted a clinically worse phenotype associated with GPA compared to MPA. Cost analysis during follow-up showed tendentially increased expenditures in glucocorticoid-treated patients versus untreated (overall AAV: €8728 vs. €7911; GPA: €9292 vs. €9143; MPA: €5967 vs. €2390), mainly driven by drugs (AAV: €2404 vs. €874; GPA: €2510 vs. €878; MPA: €1881 vs. €854) and hospitalizations. Conclusion Among AAV forms, GPA resulted in a worse clinical picture, higher mortality, and increased costs. This is the first real-world pharmaco-economic analysis on AAV patients stratified by glucocorticoid use on disease management expenditures. In both GPA and MPA patients, glucocorticoid treatment resulted in higher healthcare costs, mostly attributable to medications, and then hospitalizations, confirming the clinical complexity and economic burden for management of patients with autoimmune diseases under chronic immunosuppression. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02681-0.

show abstract

Section: Discussionmentioning

confidence: 99%

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy

Degli Esposti,

Dovizio,

Perrone

et al. 2023

Adv Ther

View full text Add to dashboard Cite

show abstract

“…Furthermore, it was previously reported that older patients showed an increased risk of a severe course of disease, including glomerulonephritis, compared to younger patients. Most cases of IgA vasculitis have a favorable prognosis, but 10-40% of IgA vasculitis cases involve the gastrointestinal system and 10-55% involve the kidneys [4,5]. Renal complications are known as the main cause of morbidity and mortality in individuals suffering from IgA vasculitis [6].…”

Section: Discussionmentioning

confidence: 99%

Sudden Onset of IgA Vasculitis Affecting Vital Organs in Adult Patients following SARS-CoV-2 Vaccines

et al. 2022

View full text Add to dashboard Cite

IgA vasculitis is an immune complex-mediated small-vessel vasculitis that mainly occurs in children and is characterized by palpable purpura, arthralgia, abdominal pain, and glomerulonephritis. We report three cases of new-onset IgA vasculitis involving major organs in adult patients after they received either the ChAdOx1 viral vector (Oxford/AstraZeneca) vaccine or the messenger RNA-1273 (Moderna) vaccine. These cases suggest that COVID-19 vaccines have the potential to trigger IgA vasculitis and indicate that physicians need to monitor for this possible complication.

show abstract

“…We further divided EGPA patients into two groups according to baseline data: patients with GI involvement and patients without GI involvement. GI involvement was defined as: (1) eosinophilic infiltration of GI mucosa or GI tract vasculitis confirmed by histopathological examination; and/or (2) GI symptoms supported by radiologic or endoscopic evidence and cannot be explained by other underlying causes other than EGPA; and/or (3) GI manifestations present at diagnosis or recurrence of vasculitis and improve after the treatment of immunomodulatory agents ( 17 – 19 ). We compared the clinical data, treatment, and outcome of EGPA patients with GI involvement and EGPA patients without GI involvement.…”

Section: Methodsmentioning

confidence: 99%

Clinical characteristics and long-term outcome of patients with gastrointestinal involvement in eosinophilic granulomatosis with polyangiitis

Chen

Zhang

et al. 2023

Front. Immunol.

View full text Add to dashboard Cite

ObjectiveThis study aims to investigate clinical characteristics, potential risk factors, as well as long-term outcome in EGPA patients with GI involvement.MethodsA total of 94 EGPA patients were included in this cohort study. We retrospectively reviewed the clinical data, treatment, and outcome of 21 EGPA patients with GI involvement and compared them with other 73 EGPA patients without GI involvement. Multivariate logistic regression was used to find potential risk factors associated with GI involvement in EGPA patients.ResultsCompared with EGPA patients without GI involvement, EGPA patients with GI involvement had higher level of hs-CRP (65.1 (24.5-138.9) vs. 21.3 (5.7-39.1) mg/L, p=0.005), higher grades of Birmingham vasculitis activity score (BVAS) (20 (13-29.5) vs. 12 (16-19), p=0.022), higher Five Factor Score (FFS) (1 (1-2) vs. 0 (0-1), p<0.001), and were more likely to have weight loss (66.7% vs. 38.4%, p=0.021) at baseline. In EGPA patients with GI involvement, the most common gastrointestinal symptoms were abdominal pain (90.5%) and diarrhea (42.9%). Weight loss was identified as a potential risk factor for GI involvement in EGPA patients (OR = 4.304, 95% CI 1.339–13.841). During follow-up, EGPA patients with GI involvement showed lower 1-year cumulative survival rate (75.2% vs. 100.0%, P <0.0001) and 3-year cumulative survival rate (67.7% vs. 100.0%, P<0.0001), lower long-term remission rate (33.3% vs. 86.3%, P<0.001), but higher 1-year cumulative relapse rate (19.2% vs. 3.8%, P=0.03) and 3-year cumulative relapse rate (54.6% vs. 13.1%, P<0.001) compared with patients without GI involvement.ConclusionEGPA patients with GI involvement had distinct features from those without GI involvement, including higher hs-CRP level, higher BVAS and FFS scores. EGPA patients with GI involvement showed lower cumulative survival rate, lower long-term remission rate and higher cumulative relapse rate compared with those without GI involvement.

show abstract

Characteristics and risk factors for poor outcome in patients with systemic vasculitis involving the gastrointestinal tract

Cited by 15 publications

References 18 publications

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy

Sudden Onset of IgA Vasculitis Affecting Vital Organs in Adult Patients following SARS-CoV-2 Vaccines

Clinical characteristics and long-term outcome of patients with gastrointestinal involvement in eosinophilic granulomatosis with polyangiitis

Contact Info

Product

Resources

About