Treatment and its side effects in ANCA-associated vasculitides – Study based on POLVAS registry data

Biedroń, Grzegorz; Włudarczyk, Anna; Wawrzycka-Adamczyk, Katarzyna; Wójcik, Krzysztof; Sznajd, J; Zdrojewski, Zbigniew; Masiak, Anna; Czuszyńska, Zenobia; Majdan, Maria; Jeleniewicz, Radosław; Klinger, Marian; Jakuszko, Katarzyna; Rowaiye, Olumide Olatubosun; Brzosko, Marek; Brzosko, Iwona; Dębska‐Ślizień, Alicja; Storoniak, Hanna; Tłustochowicz, Witold; Kur-Zalewska, Joanna; Wisłowska, Małgorzata; Madej, Marta; Hawrot-Kawecka, Anna; Głuszko, Piotr; Kucharz, Eugene J.; Musiał, Jacek; Szczeklik, Wojciech

doi:10.1016/j.advms.2020.01.002

Cited by 16 publications

(24 citation statements)

References 39 publications

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“…In the literature, the rate of use of the combination treatment containing CYC and corticosteroid ranges from 74 to 85%, 10,11 which was lower than that in our study (98.3%). Recent studies have also shown that the combination of RTX, CYC, and glucocorticoid effectively induce remission in severe ANCA vasculitis.…”

Section: Survival Function Censoredcontrasting

confidence: 79%

“…The mortality rate in Polish Vasculitis (POLVAS) registry was reported to be as low as 10%. 10 In our study, the mortality rate was also lower, compared to the reported rates (16.7% vs. 22 to 27%, respectively). 2,11,12 The lower mortality rate in this study can be attributed to the younger age of the patients and regular follow-up in a single center.…”

Section: Discussioncontrasting

confidence: 60%

“…The total administered CYC dose in our study was lower than the doses reported in other works (4.5 g vs. 7.9 to 14 g, respectively). 10,23 This difference can be attributed to the reduced need for CYC as a result of the use of RTX/CYC. The mean total RTX dose administered in our study was similar to the doses reported in the literature (4 g vs. 2 to 8 g).…”

Section: Survival Function Censoredmentioning

confidence: 99%

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Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Tufan

Tekkarismaz

2021

Arch Rheumatol

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Objectives:The aim of this study was to identify predictors of mortality in granulomatosis with polyangiitis (GPA) patients and to seek the ways of improving survival in GPA patients. Patients and methods: Between January 2005 and June 2020, a total of 60 patients (26 males, 34 females; median age: 49 years; range, 19 to 75 years) who were diagnosed with GPA were retrospectively analyzed. Demographic, clinical, laboratory, and radiological findings of all patients were recorded. Survival rates were analyzed using the Kaplan-Meier plot. Results: The median follow-up was 36 months, and 10 (16.7%) patients died during the study period. Univariate analysis showed that the prognostic values were attributed to high serum creatinine levels (>2.1 mg/dL; p=0.01), proteinuria (p=0.01), dialysis-requiring renal damage at the time of diagnosis (p=0.01) or at any time during follow-up (p=0.01), low lymphocyte levels (p=0.01), hypoalbuminemia (p=0.04), absence of upper respiratory tract involvement (p=0.01), presence of lung involvement with cavitary lesions (p=0.01), high Birmingham Vascular Activity Score (p=0.02), and history of serious infection (p=0.01). In the multivariate analysis, the presence of renal damage requiring dialysis at any time during follow-up (relative risk [95% confidence interval]: 21 [4.1-18.3]; p=0.01) was found to be an independent predictor of mortality. Immunosuppressive drugs exerted no effect on mortality, and the most common causes of death were infections (50%). Conclusion:The presence of dialysis-requiring renal damage is the most important risk factor for mortality in GPA patients. These patients should be followed more closely and carefully to improve survival.

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Section: Survival Function Censoredcontrasting

confidence: 79%

Section: Discussioncontrasting

confidence: 60%

Section: Survival Function Censoredmentioning

confidence: 99%

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Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Tufan

Tekkarismaz

2021

Arch Rheumatol

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“…[28][29][30] With the development of pharmacology, MTX began to be used gradually for the treatment of autoimmune diseases, especially for RA. [9][10][11][12][13][14][15][16][17] The effects of MTX in the treatment for large-vessel vasculitis are controversial. For TAK treatment, randomized clinical trials have not been carried out until now.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] In recent years, MTX has also been used against other autoimmune diseases, such as vasculitis and systemic lupus erythematosus. [13][14][15][16][17] However, for TAK treatment, no randomized clinical trial has been carried out until now. A few case reports or small-sample studies have suggested that lowdose MTX appeared to be an efficacious, safe, and GC-sparing agent in TAK treatment.…”

Section: Effectiveness and Safety Of Methotrexate Versus Leflunomide mentioning

confidence: 99%

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

Sun

Cui

et al. 2020

Therapeutic Advances in Chronic Disease

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Aims: The study investigates the effectiveness and safety of methotrexate (MTX) versus leflunomide (LEF) in 12-month treatment of Takayasu arteritis (TAK). Methods: This was a cohort study. Patients diagnosed with TAK between 1 January 2013 and 1 January 2019 were enrolled from First Hospital of China Medical University and Zhongshan Hospital of Fudan University. Patients had active disease and were treated with glucocorticoid combined with LEF or MTX. Treatment response, imaging assessment and side-effects were evaluated during 12-month follow-up. Results: In total, 68 patients were enrolled (40 cases treated with LEF and 28 treated with MTX). At baseline, age, sex, disease duration and disease activity index showed no significant differences between groups. Prevalence of complete remission (CR) at 6 months was significantly higher in the LEF group than that in the MTX group (LEF versus MTX: 72.50% versus 53.57%, p = 0.04), though the CR prevalence at 9 months and 12 months showed no significant differences between groups. At 9 months, the prevalence of treatment resistance was much lower in the LEF group compared with MTX group (5.41% versus 11.54%, p = 0.03). Furthermore, prevalence of disease relapse in the LEF group was lower than that in MTX group at 12 months (7.24% versus 16.67%, p = 0.03). Patients with high baseline C-reactive protein levels (⩾15 mg/L) carried a higher risk of treatment resistance (OR = 1.36, 95% CI 1.07–13.41, p = 0.06) and disease relapse (HR = 2.51, 95% CI 1.36–12.98, p = 0.04). Conclusion: LEF might provide a quicker treatment response with lower prevalence of disease relapse compared with that elicited in MTX during 12 months follow-up for TAK.

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The frequency of Treg subsets distinguishes disease activity in ANCA vasculitis

Agosto-Burgos

Iannone

et al. 2022

Clin & Trans Imm

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Objectives. T regulatory cells (Tregs) are a heterogeneous group of immunoregulatory cells that dampen self-harming immune responses and prevent the development of autoimmune diseases. In anti-neutrophil cytoplasmic autoantibody (ANCA) vasculitis, Tregs possess diminished suppressive capacity, which has been attributed to the expression of a FOXP3 splice-variant lacking exon 2 in T cells (FOXP3D2 CD4 + T cells). However, the suppressive capacity of Tregs varies between subsets. We evaluated the frequency of Treg subsets in ANCA vasculitis as a potential explanation for diminished suppressive capacity. Methods. We developed a custom mass cytometry panel and performed deep immune profiling of Tregs in healthy controls, patients with active disease and in remission. Using these data, we performed multidimensional reduction and discriminant analysis to identify associations between Treg subsets and disease activity. Results. Total Tregs were expanded in ANCA vasculitis, which was associated with remission and the administration of rituximab and/or prednisone. The frequency of FOXP3D2 CD4 + T cells did not distinguish disease activity and this population had high expression levels of CD127 and lacked both CD25 and Helios, suggesting that they are not conventional Tregs. The frequency of CXCR3 + , CD103 + and CCR7 + Tregs distinguished disease activity, and the combination of the frequency of these three Treg subsets segregated active patients from patients in remission and healthy controls. From these three subsets, the frequency of CXCR3 + Tregs distinguished patients with active disease with renal involvement. Conclusion. Treg heterogeneity can discriminate disease activity and should be explored as a biomarker of disease activity in ANCA vasculitis.

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Treatment and its side effects in ANCA-associated vasculitides – Study based on POLVAS registry data

Cited by 16 publications

References 39 publications

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Predictive factors of mortality in granulomatosis with polyangiitis: A single-center study

Effectiveness and safety of methotrexate versus leflunomide in 12-month treatment for Takayasu arteritis

The frequency of Treg subsets distinguishes disease activity in ANCA vasculitis

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