Clinical features and long‐term outcomes of 105 granulomatosis with polyangiitis patients: A single center experience from north India

Sharma, Aman; Naidu, Gsrsnk; Rathi, Manish; Verma, Roshan; Modi, Manish; Pinto, Benzeeta; Sharma, Kusum; Dhir, Varun; Singhal, Manphool; Prakash, Mahesh; Nada, Ritambhra; Panda, Naresh K.; Minz, Ranjana W.

doi:10.1111/1756-185x.13071

Cited by 32 publications

(31 citation statements)

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“…The conventional understanding of granulomatosis with polyangiitis (GPA) in Asia was influenced by studies from Japan, which suggested MPO‐positive GPA as a dominant phenotype in Asia. This understanding was recently expanded by reports of PR3‐positive GPA from India . Our group also showed that renal involvement is milder and does not portend a poor prognosis .…”

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confidence: 59%

Vasculitis research: Moving east

Sharma

2019

Int J of Rheum Dis

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It gives me immense pleasure to present this special issue of the International Journal of Rheumatic Diseases on "Vasculitis." I thank the editor-in-chief Professor Danda for asking me to be the guest editor with a brief that this issue should give an overview of the recent advances in various vasculitic disorders from all over the world, with a focus on contributions from the APLAR region. The topics for this supplement have been chosen keeping in mind their relevance both to avid researchers in the field and practicing rheumatologists. The supplement starts with a tribute to Professor Paul Bacon, whom unfortunately we recently lost. He was a stalwart of the field, a champion of collaborative research and was a great support to the Indian Rheumatology Association vasculitis (IRAVAS) research group. He was the guiding force behind the development and validation of Indian Takayasu Clinical Activity Score (ITAS2010). 1 There have been significant advancements in the field of various vasculitides in recent times. The first write-up by Durga et al is on current trends and future directions in vasculitis research. 2 This is an exhaustive review, which summarizes the research published in the field of large vessel vasculitis (LVV), and antineutrophil cytoplasmic antibody-associated vasculitis (AAV) in the last 3 years and also details the studies that are in the pipeline and would be looked up to in the coming years. The write-up ends with a perspective of vasculitis research from a viewpoint of developing countries and resource-poor settings. There have been significant developments in nomenclature and classification of various vasculitic disorders. The draft classification criteria of AAV, which are an outcome of the data-driven multi-center Diagnostic and Classification Criteria for Vasculitis study (DCVAS), were presented at the American College of Rheumatology 2017 meeting in San Diego, USA in November, 2017. The next write-up is by Richard Watts on evolving concepts in classification of systemic vasculitis, the stage at which the various new criteria are and what is the way forward?. 3 The next section is on LVV. The first write-up by Tanaz Kermani discusses the similarities and differences in giant cell arteritis (GCA) and Takayasu arteritis (TAK) and whether they are a spectrum of the same disease. 4 The shared clinical, histopathologic and radiographic features of GCA and TAK suggest that the two conditions may be a spectrum of the same disease. However, the geographical differences, association with different major histocompatibility complex classes and differential treatment responses to same biological agents suggest that these may not be same. Then there is a detailed write-up by Jiang's group on the role of radiology and biomarkers in assessing disease activity in TAK. 5 The precise assessment of TAK disease activity has been a challenge in clinical practice. The role of positron emission tomography/computed tomography, magnetic resonance imaging, CT angiography and contrast ultrasound in assessing diseas...

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confidence: 59%

Vasculitis research: Moving east

Sharma

2019

Int J of Rheum Dis

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“…A comparison of 657 AAV patients included in clinical trials vs 437 followed up in observational cohorts worldwide revealed that those included in clinical trials were older and had more severe disease at baseline; the clinical trial subjects with GPA but not MPA had greater mortality and relapses in comparison to the real‐world patients . It had been commonly believed that Asian patients (mostly from Japanese cohorts) with GPA have greater MPO‐ANCA positivity than Caucasian patients; however, a recent large cohort of GPA from North India challenged this conventional thinking, with a greater proportion of PR3‐ANCA than MPO‐ANCA positive patients in this cohort …”

Section: Anca Vasculitismentioning

confidence: 99%

Vasculitis research: Current trends and future perspectives

et al. 2018

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We discuss recent and prospective research in small and large vessel vasculitis. Large cohorts of Takayasu arteritis (TA) have been recently published from across the world, clarifying our understanding of this uncommon disease. Novel open-ended approaches like large-scale genotyping, proteomics and metabolomics have helped gain novel insights into TA, giant cell arteritis (GCA) and anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Recent advances in the imaging of TA and GCA offer promise for earlier diagnosis and better monitoring of response to therapy. Although two randomized controlled trials of abatacept and tocilizumab failed to meet their primary end-points, successful large-scale studies of abatacept and tocilizumab in GCA hold promise for better disease control. While cyclophosphamide has revolutionized the management of AAV, increasing use of rituximab as an alternative induction regimen, as well as use of novel approaches involving reduced or no corticosteroid use for AAV and alternative agents such as avacopan (a complement 5a receptor antagonist) hold promise for lesser toxic induction regimens in the future. Increasingly, the risk of cardiovascular events and comorbidities such as osteoporosis are being recognized as factors affecting long-term prospects of patients with vasculitis. There is a shift in emphasis to utilize patient-reported outcomes to more accurately gauge the impact of vasculitides and their treatment.

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“…The prevalence among Iranian children younger than 15 years was estimated to be 0.6/million . Even though various case series on GPA have been described from India, Korea and other Asian countries, none of them has estimated the prevalence or incidence of GPA …”

Section: Epidemiologymentioning

confidence: 99%

Is granulomatosis with polyangiitis in Asia different from the West?

et al. 2018

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The incidence and clinical features of antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) have been shown to vary according to geographical areas, with granulomatosis with polyangiitis (GPA) being more common in northern Europe and microscopic polyangiitis (MPA) being more common in Asian countries.The annual incidence of GPA among Asians varies between 0.37/million to 2.1/million population. The prevalence of GPA has been estimated to be 1.94/100 000 in a Chinese population. Polymorphisms in class II major histocompatibility genes and ETS1 proto-oncogene has been shown in Asian patients with GPA. There is a difference in mean age at onset and proteinase 3 (PR3) or myeloperoxidase (MPO) positivity in GPA patients from different Asian countries. Those from India had mean age of 40 years and those from Japan had mean age of 65 years. Sixty percent of GPA patients from China and Japan were MPO ANCA positive while the majority of patients from India and Korea were PR3 positive. Geographical variation with lower frequency of renal involvement in Indian studies and higher frequency in Chinese patients has also been noted. Treatment outcomes have been similar to those reported from other parts of the world. Remission was achieved in about two-thirds of patients while relapses were noted in one-third to half of the patients. Apart from minor differences in the organ systems involved, MPO-ANCA GPA and PR3-ANCA GPA had similar rates of remission and relapses. K E Y W O R D S Asia, granulomatosis with polyangiitis, vasculitisWe searched PubMed using the search terms "Granulomatosis with polyangiitis", "GPA" and "Wegener's granulomatosis". We screened for articles published from Asian countries and describing the epidemiology, pathogenesis, clinical features and outcomes of GPA patients. Case reports and small case series of less than 5 patients were not included. The basis of diagnosis of GPA in different studies was either histopathology suggestive of GPA or fulfilling the American College of Rheumatology (ACR) criteria for GPA or classified according to European Medicines Evaluation Agency classification. We also included large case series on GPA from Europe and USA to compare them with Asian studies. | EPID EMIOLOGYThe incidence and prevalence of GPA shows a regional and ethnical difference with higher incidence of GPA in northern Europe and lower incidence in Asian countries. 1 The precise estimates of incidence and prevalence of AAV and GPA are not available from Asian countries. In the epidemiological study by Fujimoto et al, 1 the annual incidence of GPA in Japan was calculated to be 2.1/million population, which was much lower than that noted in the UK (annual incidence of 14.3/million). The annual incidence of MPA was higher in Japan than the UK and the overall incidence of all AAV was similar between Japan and the UK. Liu et al 7 used DIS-MOD II software to estimate prevalence based on the inpatient data of GPA patients in 100 hospitals across China. They estimated the prevalence of GPA to be 1...

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Clinical features and long‐term outcomes of 105 granulomatosis with polyangiitis patients: A single center experience from north India

Cited by 32 publications

References 10 publications

Vasculitis research: Moving east

Vasculitis research: Moving east

Vasculitis research: Current trends and future perspectives

Is granulomatosis with polyangiitis in Asia different from the West?

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