Clinical outcomes of ANCA-associated vasculitis in elderly patients

Haris, Ágnes; Polner, Kálmán; Arányi, József; Braunitzer, Henrik; Kaszás, Ilona; Mucsi, István

doi:10.1007/s11255-014-0717-y

Cited by 21 publications

(18 citation statements)

References 23 publications

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“…A small retrospective study, including only 52 patients over 65 years (and very few over 75 years), showed no difference in the treatment effects (including rates of leukopenia, severe infection and eGFR level) of a dose reduction with intravenous cyclophosphamide with age, and relapse rates were slightly but not significantly lower in the elderly [17]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

Judge

Reschen²,

Haynes³

et al. 2016

Nephron

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Background/Aims: Anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) is a cause of biopsy-proven acute kidney injury, more common in the elderly. Treatment requires immunosuppression, which can have significant toxic effects. The aim of this study was to assess whether morbidity and mortality that are associated with immunosuppression for AAV varied with age. Methods: A retrospective review of 232 patients given induction therapy with prednisolone and cyclophosphamide was conducted. Information was collected on baseline characteristics (including requirement for dialysis at presentation) and the occurrence of leukopenia, infection, end-stage renal disease and death during follow-up. Results: Median follow-up was 51 months. Older patients (aged ≥70 years) were treated with lower total cyclophosphamide doses than those aged <70 years (mean 7.3 g (SD 4.4) vs. 10.7 g (SD 7.4), respectively). Increasing age was associated with an increased risk of leukopenia (odds ratio (OR) 1.50; 95% confidence interval (CI) 1.20-1.86; p < 0.001), and older patients were more likely to develop infections in the first year (OR 1.87; 95% CI 1.1-3.2). Older patients were also significantly more likely to require dialysis at presentation (OR 1.66; 95% CI 1.13-2.5) and longer term. After multivariable adjustment, age and requirement for dialysis at presentation were significant predictors of death (hazard ratio (HR) per year of age 1.07; 95% CI 1.03-1.11; p < 0.001 and HR 2.2; 95% CI 1.10-4.38; p = 0.03, respectively). Conclusions: Among patients treated with prednisolone and cyclophosphamide, increasing age and dialysis dependency were associated with worse survival. Older patients were more likely to develop treatment-related complications despite lower cumulative doses of immunosuppression. Morbidity and mortality associated with treatment must therefore be carefully balanced against that associated with the disease process itself.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

Judge

Reschen²,

Haynes³

et al. 2016

Nephron

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“…In this cohort, the morbidity and mortality were very high, with nearly 70% of patients reaching the combined end-point of ERSD or death within the first year. In another report, Haris et al [17] defined elderly patients as those aged 65 years or more and also found higher mortality in the older than in the younger patients with AAV, even though the percentage of deaths within the first year did not significantly differ (37 vs. 27%, p = 0.22).…”

Section: Prognosis Of Elderly Patients With Rpgnmentioning

confidence: 99%

“…On the other hand, elderly patients aged above 75 years were typically excluded from these trials. There is therefore relatively little data on the prognosis of elderly (and very elderly) patients with AAV [14-17]. …”

Section: Prognosis Of Elderly Patients With Rpgnmentioning

confidence: 99%

Management of Elderly Patients with Rapidly Progressive Glomerulonephritis

Hrušková¹,

Tesař²

2018

Blood Purif

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Background: Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid deterioration of renal function and by extracapillary proliferation in >50% of glomeruli. The most common type of RPGN is “pauci-immune” glomerulonephritis caused by anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV). Summary: The incidence of AAV increases with age and pauci-immune glomerulonephritis is the most common diagnosis found in renal biopsies in the elderly population. Age was identified as an independent negative risk factor for both death and end-stage renal disease in AAV, and the mortality of older patients was uniformly higher than in younger patients in all retrospective studies. Early diagnosis may be difficult particularly in elderly patients with renal-limited disease but is important for the good outcome of the patients. Immunosuppressive treatment options include cyclophosphamide or rituximab combined with corticosteroids with or without plasma exchange in case of severe disease. Data from randomized trials are completely missing for patient aged >75 years. Based on retrospective studies, elderly patients seem to respond to immunosuppressive drugs just as younger patients are able to, but they are at a higher risk of adverse events. Key Messages: RPGN is relatively common in the elderly patients. Immunosuppressive treatment in older patients with AAV or RPGN may be useful but needs to be strictly individualized with all the risks taken into consideration. Further studies are needed to examine the role of novel therapeutic options in the elderly population with RPGN.

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“…have usually more severe organ damage, respond less satisfactorily to treatment, are more susceptible to secondary infections, and have a poorer prognosis. [3][4][5] DAH is well known as a serious AAV symptom associated with high mortality. The guidelines suggest considering the addition of plasma exchange to corticosteroid and cyclophosphamide therapy in patients with advanced kidney dysfunction and severe DAH.…”

Section: Clinical Imagementioning

confidence: 99%

Diffuse alveolar hemorrhage as an initial presentation of ANCA‑associated vasculitis in an 80‑year‑old man

Masiak¹,

Buda²,

Wojteczek³

et al. 2017

Polish Archives of Internal Medicine

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Clinical outcomes of ANCA-associated vasculitis in elderly patients

Abstract: Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.

Cited by 21 publications

References 23 publications

Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

Outcomes of Elderly Patients with Anti-Neutrophil Cytoplasmic Autoantibody-Associated Vasculitis Treated with Immunosuppressive Therapy

Management of Elderly Patients with Rapidly Progressive Glomerulonephritis

Diffuse alveolar hemorrhage as an initial presentation of ANCA‑associated vasculitis in an 80‑year‑old man

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