1
|
Alamo BS, Moi L, Bajema I, Berden A, Flossmann O, Hruskova Z, Jayne D, Trejo MW, Wallquist C, Westman K. Long-term outcome of kidney function in patients with ANCA-associated vasculitis. Nephrol Dial Transplant 2024:gfae018. [PMID: 38268409 DOI: 10.1093/ndt/gfae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Kidney involvement is common in ANCA associated vasculitis (AAV) and prognosis determined by the severity of kidney damage. This study focused on long-term kidney outcomes, defining possible risk factors and comparing the performance of three different histological classifications to predict outcomes for patients with AAV. METHODS The dataset included 848 patients with newly diagnosed AAV who participated in 7 RCTs (1995-2012). Follow up information obtained from questionnaires sent to the principal investigators of the original RCTs. RESULTS The cumulative incidence of end-stage kidney disease (ESKD) at 5 and 10 years was 17% and 22%, respectively. Patients who developed ESKD had reduced patient survival compared to those with preserved kidney function (HR: 2.8, P-value < 0.001). Comparing patients with AAV and kidney involvement to a matched general population, patients with AAV had poor survival outcomes, even in early stages of CKD. The main cause of death was infection followed by cardiovascular disease in patients developing ESKD and malignancy in those who did not. 34% of patients with initial need for dialysis recovered kidney function after treatment. 35 out of 175 in need of kidney replacement therapy (KRT) during follow up received a kidney transplant with good outcome; 86% patient survival at 10 years.In the subcohort of 214 patients with available kidney biopsies, three scoring systems were tested: the Berden classification, the Renal Risk Score (RRS), and the Mayo Clinic Score (MCCS). The scores highlighted the importance of normal glomeruli and severe glomerulosclerosis on kidney survival (P < 0.001 and P = 0.001, respectively). The RRS demonstrated a moderate prediction of kidney survival (AUC: 0.79; SE: 0.03, 95% CI: 0.71-0.83). CONCLUSIONS Early diagnosis is extremely important. Even milder forms of kidney involvement have an impact on the prognosis. Patients in need of KRT had the lowest survival rates, but kidney transplantation has shown favorable outcomes for eligible AAV patients. The three histologic scoring systems were all identified as independent prognostic factors for kidney outcome.
Collapse
Affiliation(s)
- Beatriz Sanchez Alamo
- Department of Clinical Sciences Lund, Division of Nephrology, Lund University, Sweden, & Dept. Nephrology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Laura Moi
- Division of Immunology and Allergy Dept. of Medicine, University Hospital of Lausanne, Lausanne University, Switzerland
| | | | - Annelies Berden
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Zdenka Hruskova
- Department of Nephrology, General Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Jayne
- Department of Medicine, University of Cambridge, United Kingdom
| | - Maria Wester Trejo
- Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Carin Wallquist
- Department of Nephrology, Skane Univ. Hospital Malmö, Sweden
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Division of Nephrology, Lund University, Sweden
| |
Collapse
|
2
|
Sánchez Álamo B, Moi L, Bajema I, Faurshou M, Flossmann O, Hauser T, Hruskova Z, Jayne D, Luqmani R, Mahr A, Åkesson A, Westman K. Long-term outcomes and prognostic factors for survival of patients with ANCA-associated vasculitis. Nephrol Dial Transplant 2023:6973211. [PMID: 36617233 DOI: 10.1093/ndt/gfac320] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite newer treatments with immunosuppressive agents, there still exists a considerable morbidity and mortality risk among patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). Since 1994 the European Vasculitis Society (EUVAS) has aimed for an improved outcome for patients with AAV by several prospective randomized clinical trials (RCTs). The aim for the present study was to further evaluate the long-term survival of patients with AAV included in seven RCTs conducted by the EUVAS, as well as to identify potential prognostic factors. METHODS Long-term follow-up data were collected from questionnaires sent to the principal investigators of the original RCTs (1995-2012): MEPEX, NORAM, CYCAZAREM, CYCLOPS, IMPROVE, RITUXVAS and MYCYC, comprising 848 patients, all newly diagnosed with AAV. Relative survival estimates are presented for the study cohorts. Demographic, clinical and laboratory characteristics at trial entry were studied as potential prognostic factors in multivariable models. RESULTS 478 (56%) patients had Granulomatosis with polyangiitis (GPA) and 370 (44%) Microscopic polyangiitis (MPA) with a mean age at diagnosis of 58 ± 14 years. Median follow-up time was 8 years (IQR: 2.9-13.6). During the observation period, there were 305 deaths and the main causes were infections (26%), cardiovascular disease (14%) and malignancies (13%). When compared to a matched cohort, (regarding country, age-group, and sex) from the background population there was 14.2% more deaths among our cohort of AAV patients at 5 years, 19.9% at 10 years, 28.8% at 15 years and 36.3% at 20 years. The excess mortality occurred in all age groups. Estimated median survival time (from diagnosis) was 17.8 years (95%CI: 15.7-20). Among variables measured at baseline, advanced age, male sex, low estimated glomerular filtration rate, and low platelet count were identified as predictors of death in a multivariate Cox model. CONCLUSIONS Patients with AAV still have an increased risk of mortality compared to the general population despite newer therapeutic regimens. Treatment complications and organ damage are the main causes of limited survival, and infections remain the leading cause of mortality among patients with AAV.
Collapse
Affiliation(s)
- Beatriz Sánchez Álamo
- Department of Clinical Sciences Lund, Division of Nephrology Lund University, Sweden
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, University Hospital of Lausanne, Lausanne University, Switzerland
| | - Ingeborg Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mikkel Faurshou
- Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, Berkshire, United Kingdom
| | | | - Zdenka Hruskova
- Department of Nephrology, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Raashid Luqmani
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Alfred Mahr
- Clinic for Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anna Åkesson
- Clinical Studies Sweden Forum South, Skane University Hospital Lund, Sweden
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Division of Nephrology Lund University, Sweden.,Department of Nephrology, Skane University Hospital Malmö-Lund, Sweden
| | | |
Collapse
|
3
|
Egan AC, Kronbichler A, Neumann I, Bettiol A, Carlson N, Cid MC, Emmi G, Gopaluni S, Harper L, Hauser T, Little MA, Luqmani RA, Mahr A, McClure M, Mohammad AJ, Nelveg-Kristensen KE, Ohlsson S, Peh CA, Rutherford M, Sanchez Alamo B, Scott J, Segelmark M, Smith RM, Szpirt WM, Tomasson G, Trivioli G, Vaglio A, Walsh M, Wester Trejo M, Westman K, Bajema IM, Jayne DR. The Sound of Interconnectivity; The European Vasculitis Society 2022 Report. Kidney Int Rep 2022; 7:1745-1757. [PMID: 35967106 PMCID: PMC9366365 DOI: 10.1016/j.ekir.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022] Open
Abstract
The first European Vasculitis Society (EUVAS) meeting report was published in 2017. Herein, we report on developments in the past 5 years which were greatly influenced by the pandemic. The adaptability to engage virtually, at this critical time in society, embodies the importance of networks and underscores the role of global collaborations. We outline state-of-the-art webinar topics, updates on developments in the last 5 years, and proposals for agendas going forward. A host of newly reported clinical trials is shaping practice on steroid minimization, maintenance strategies, and the role of newer therapies. To guide longer-term strategies, a longitudinal 10-year study investigating relapse, comorbidity, malignancy, and survival rates is at an advanced stage. Disease assessment studies are refining classification criteria to differentiate forms of vasculitis more fully. A large international validation study on the histologic classification of anti-neutrophil cytoplasmic antibody (ANCA) glomerulonephritis, recruiting new multicenter sites and comparing results with the Kidney Risk Score, has been conducted. Eosinophilic granulomatosis with polyangiitis (EGPA) genomics offers potential pathogenic subset and therapeutic insights. Among biomarkers, ANCA testing is favoring immunoassay as the preferred method for diagnostic evaluation. Consolidated development of European registries is progressing with an integrated framework to analyze large clinical data sets on an unprecedented scale.
Collapse
|
4
|
Ludl A, Westman K, Wallquist C. [Patients with IgA nephropathy often develop terminal uraemia]. Lakartidningen 2022; 119:21154. [PMID: 35147207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
IgA nephropathy is the most common form of inflammatory kidney disease causing uraemia world-wide and initially often a silent disease with microscopic haematuria as the only clinical finding. If left untreated, progress to terminal uraemia and dialysis is not uncommon as at least 30 % develop end stage renal failure. Awareness of the existence of the disease among GPs, internists and urologists may be helpful, not disregarding microscopic haematuria, particularly in combination with albuminuria or finding of renal casts in the urine, especially in younger individuals. No diagnostic marker in blood or urine for the disease has yet been established so kidney biopsy is still needed to confirm diagnosis. The degree of renal dysfunction, hypertension, albuminuria, and histology findings at time of diagnosis have significant impact on renal outcome. Potential biomarkers for progressive disease have been described but no one has so far been implicated in clinical practice. Until now, the only evidence-based medication consists of blockers of the renin-angiotensin-system and corticosteroids. However, new and potentially more specific drugs are under clinical investigation. Early intervention is mandatory to prevent disease progression. Thus, we want to alarm other specialists to an increased alertness for this disease, referring patients at an early stage of possible IgA nephropathy to the nephrologist for diagnosis and interventions.
Collapse
Affiliation(s)
- Anna Ludl
- MD, ST-läkare, Njurmedicinska sektionen, Skånes universitetssjukhus Malmö
| | - Kerstin Westman
- MD, docent, överläkare, Njurmedicinska sektionen, Skånes universitetssjukhus Malmö/Lund
| | - Carin Wallquist
- MD, PhD, överläkare, Njurmedicinska sektionen, Skånes universitetssjukhus Malmö
| |
Collapse
|
5
|
Stevens KI, Frangou E, Shin JIL, Anders HJ, Bruchfeld A, Schönermarck U, Hauser T, Westman K, Fernandez-Juarez GM, Floege J, Goumenos D, Turkmen K, van Kooten C, McAdoo SP, Tesar V, Segelmark M, Geetha D, Jayne DRW, Kronbichler A. OUP accepted manuscript. Nephrol Dial Transplant 2022; 37:1400-1410. [PMID: 35244174 PMCID: PMC9383521 DOI: 10.1093/ndt/gfac052] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Jae I l Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Ulf Schönermarck
- Division of Nephrology, Department of Internal Medicine IV, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Kerstin Westman
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | | | - Jürgen Floege
- Division of Nephrology, RWTH Aachen University Hospital, Aachen, Germany
| | - Dimitrios Goumenos
- Department of Nephrology and Renal Transplantation, Patras University Hospital, Patras, Greece
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Cees van Kooten
- Division of Nephrology and Transplant Medicine, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
6
|
Moiseev S, Kronbichler A, Makarov E, Bulanov N, Crnogorac M, Direskeneli H, Galesic K, Gazel U, Geetha D, Guillevin L, Hrušková Z, Little MA, Ahmed A, McAdoo SP, Mohammad AJ, Moran S, Novikov P, Pusey CD, Rahmattulla C, Satrapová V, Silva J, Terrier B, Tesař V, Westman K, Jayne DRW. Association of venous thromboembolic events with skin, pulmonary and kidney involvement in ANCA-associated vasculitis: a multinational study. Rheumatology (Oxford) 2021; 60:4654-4661. [PMID: 33523099 DOI: 10.1093/rheumatology/keab071] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate the occurrence of venous thromboembolic events (VTE) in a large cohort of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) across the European Union, Turkey, Russia, UK, and North America. METHODS Patients with a definite diagnosis of AAV who were followed for at least 3 months and had sufficient documentation were included. Data on VTE, including either deep vein thrombosis or pulmonary embolism, were collected retrospectively from tertiary vasculitis centers. Univariate and multivariate regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Over a median follow up of 63 (29; 101) months, VTE occurred in 278 (9.7%) of 2869 AAV patients with a similar frequency across different countries (from 6.3% to 13.7%), and AAV subtype (granulomatosis with polyangiitis: 9.8%; 95% CI 8.3-11.6, microscopic polyangiitis: 9.6%; 95% CI 7.9-11.4, and eosinophilic granulomatosis with polyangiitis: 9.8%; 95% CI 7.0-13.3). Most VTE (65.6%) were reported in the first-year post diagnosis. Multiple factor logistic regression analysis adjusted for sex and age showed that skin (OR 1.71, 95% CI 1.01-2.92), pulmonary (OR 1.78, 95% CI 1.04-3.14) and kidney involvement (eGFR 15-60 mL/min/1.73 m2, OR 2.86, 95% CI 1.27-6.47; eGFR < 15 mL/min/1.73 m2, OR 6.71, 95% CI 2.94-15.33) were independent variables associated with a higher occurrence of VTE. CONCLUSION Two thirds of VTE occurred during the initial phase of active disease. We confirmed previous findings from smaller studies that a decrease in kidney function, skin involvement and pulmonary disease are independently associated with VTE.
Collapse
Affiliation(s)
- Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Egor Makarov
- Faculty of Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matija Crnogorac
- Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Kresimir Galesic
- Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia
| | - Ummugulsum Gazel
- Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Loic Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland.,Irish Centre for Vascular Biology, Tallaght University Hospital, Dublin, Ireland
| | | | - Stephen P McAdoo
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden, Vasculitis and Lupus Clinic, Addenbrooke's Hospital Cambridge University Hospitals, Cambridge, UK
| | - Sarah Moran
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Charles D Pusey
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Chinar Rahmattulla
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Veronika Satrapová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Joana Silva
- Centre for Inflammatory Disease, Department of Medicine, Imperial College London, London, UK
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Vladimír Tesař
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Prague, Czech Republic, in
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Nephrology, Lund University, Lund, Sweden
| | - David R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Heijl C, Westman K, Höglund P, Mohammad AJ. Malignancies in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis: A Population-based Cohort Study. J Rheumatol 2019; 47:1229-1237. [PMID: 31474595 DOI: 10.3899/jrheum.181438] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with ANCA-associated vasculitides (AAV) exhibit higher rates of malignancy than the general population. We assessed whether the cancer risk is increased in a well-characterized population-based cohort of AAV in southern Sweden, followed for a median time of 8 years. METHODS With case record review, the outcomes and malignancy development in a cohort of 195 patients with AAV [granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA] diagnosed between 1997 and 2010 were assessed. The patients were followed until death or December 31, 2015. The age- and sex-standardized incidence ratios (SIR) were estimated using the Swedish population data as a reference. RESULTS During the observation period of about 1500 person-years, we found 60 cancers in 52 of the 195 patients. SIR (95% CI) was 2.8 (2.1-3.6) for cancers at all sites, 1.8 (1.3-2.5) for all cancers excluding squamous cell carcinoma (SCC), 12.9 (8.4-18.8) for SCC, 4.3 (1.4-10.0) for bladder cancer, and 7.0 (1.4-20.5) for pancreatic cancer. Cumulative doses of cyclophosphamide (CYC) < 10 g were not associated with higher incidence of cancers other than SCC (SIR 1.63, 95% CI 0.8-2.9). CONCLUSION In contrast to previous publications assessing malignancy risk in patients with AAV, we show in this population-based cohort of patients a persistent increased risk for overall malignancy, bladder cancer, and pancreatic cancer as well as a markedly increased risk for SCC. There was no increase in incidence of cancers other than SCC for those treated with < 10 g CYC.
Collapse
Affiliation(s)
- Caroline Heijl
- Department of Clinical Sciences Lund, Nephrology, Lund University; Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; Department of Clinical Sciences, Rheumatology, Lund University; Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,C. Heijl, MD, PhD, Specialist in Nephrology, Department of Clinical Sciences Lund, Nephrology, Lund University; K. Westman, MD, PhD, Senior Consultant Nephrologist, Department of Clinical Sciences Lund, Nephrology, Lund University; P. Höglund, MD, PhD, Professor, Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; A.J. Mohammad, MD, MPH, PhD, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, and Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Nephrology, Lund University; Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; Department of Clinical Sciences, Rheumatology, Lund University; Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,C. Heijl, MD, PhD, Specialist in Nephrology, Department of Clinical Sciences Lund, Nephrology, Lund University; K. Westman, MD, PhD, Senior Consultant Nephrologist, Department of Clinical Sciences Lund, Nephrology, Lund University; P. Höglund, MD, PhD, Professor, Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; A.J. Mohammad, MD, MPH, PhD, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, and Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Peter Höglund
- Department of Clinical Sciences Lund, Nephrology, Lund University; Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; Department of Clinical Sciences, Rheumatology, Lund University; Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,C. Heijl, MD, PhD, Specialist in Nephrology, Department of Clinical Sciences Lund, Nephrology, Lund University; K. Westman, MD, PhD, Senior Consultant Nephrologist, Department of Clinical Sciences Lund, Nephrology, Lund University; P. Höglund, MD, PhD, Professor, Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; A.J. Mohammad, MD, MPH, PhD, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, and Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Nephrology, Lund University; Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; Department of Clinical Sciences, Rheumatology, Lund University; Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK. .,C. Heijl, MD, PhD, Specialist in Nephrology, Department of Clinical Sciences Lund, Nephrology, Lund University; K. Westman, MD, PhD, Senior Consultant Nephrologist, Department of Clinical Sciences Lund, Nephrology, Lund University; P. Höglund, MD, PhD, Professor, Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University; A.J. Mohammad, MD, MPH, PhD, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, and Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge.
| |
Collapse
|
8
|
Weiner M, Goh SM, Mohammad AJ, Hrušková Z, Tanna A, Sharp P, Kang A, Bruchfeld A, Selga D, Chocová Z, Westman K, Eriksson P, Harper L, Pusey CD, Tesař V, Salama AD, Segelmark M. Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis. J Rheumatol 2019; 47:580-588. [DOI: 10.3899/jrheum.190019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
Objective.Age is a risk factor for organ damage, adverse events, and mortality in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, the relationship between treatment and damage, hospitalizations, and causes of death in elderly patients is largely unknown.Methods.Consecutive patients from Sweden, the United Kingdom, and the Czech Republic diagnosed between 1997 and 2013 were included. Inclusion criteria were a diagnosis of MPA or GPA and age 75 years or more at diagnosis. Treatment with cyclophosphamide (CYC), rituximab (RTX), and corticosteroids the first 3 months was registered. Outcomes up to 2 years from diagnosis included Vasculitis Damage Index (VDI), hospitalization, and cause of death.Results.Treatment data were available for 167 of 202 patients. At 2 years, 4% had no items of damage. There was a positive association between VDI score at 2 years and Birmingham Vasculitis Activity Score at onset, and a negative association with treatment using CYC or RTX. Intravenous methylprednisolone dose was associated with treatment-related damage. During the first year, 69% of patients were readmitted to hospital. Myeloperoxidase–antineutrophil cytoplasmic antibody positivity and lower creatinine levels decreased the odds of readmission. The most common cause of death was infection, and this was associated with cumulative oral prednisolone dose.Conclusion.Immunosuppressive treatment with CYC or RTX in elderly patients with MPA and GPA was associated with development of less permanent organ damage and was not associated with hospitalization. However, higher doses of corticosteroids during the first 3 months was associated with treatment-related damage and fatal infections.
Collapse
|
9
|
Westman K. [Not Available]. Lakartidningen 2019; 116:FPDD. [PMID: 31192378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Kerstin Westman
- Lunds Universitet Institutionen för kliniska vetenskaper i Lund - Njurmedicin Lund, Sweden Lunds Universitet Institutionen för kliniska vetenskaper i Lund - Njurmedicin Lund, Sweden
| |
Collapse
|
10
|
Wadström J, von Zur-Mühlen B, Lennerling A, Westman K, Wennberg L, Fehrman Ekholm I. Living Anonymous Renal Donors Do Not Regret: Intermediate and Long-Term Follow-Up with a Focus on Motives and Psychosocial Outcomes. Ann Transplant 2019; 24:234-241. [PMID: 31023996 PMCID: PMC6507493 DOI: 10.12659/aot.913827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Living anonymous donation (LAD) of kidneys was introduced in Sweden in 2004. This study reports on outcomes of Swedish LAD experiences from 2004 to 2016, focusing on donors' motives, the care they received, psychosocial aspects, and medical status at follow-up. MATERIAL AND METHODS Donor data were collected through a physician interview, medical check-up, review of medical charts, the Hospital Anxiety Depression Scale (HADS), and a routine national questionnaire. Of the 26 LADs during the study period, 1 donor died and 1 declined to participate, leaving a study population of 24. RESULTS Half of the donors were male, which is a higher proportion than for directed living donors. The major motive detected was altruism. Of the 24 LADs, 96% were very satisfied and would donate again if possible, 46% noted increased self-esteem, and a third were happier after the donation. Sixty-two percent received anonymous information about the recipient and 40% would have liked to meet the recipient. HADS scores were normal. Two donors had antidepressant treatment, 1 of whom had received treatment before donation. Half mentioned that the pre-donation assessment took too long. At follow-up, mean eGFR was 62±12 mL/min/1.73 m², of which 16 were in CKD II and 8 were in CKD III. Four donors had developed hypertension, 1 of whom also developed type 2 diabetes. CONCLUSIONS Swedish LADs are very satisfied and medical outcomes are acceptable. We propose that the transplant community and the National Board of Health and Welfare take a more active approach to informing the general public about LAD.
Collapse
Affiliation(s)
- Jonas Wadström
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden.,Department of Surgery/Transplantation, Hamad Medical Corporation, Doha, Qatar
| | | | - Annette Lennerling
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Westman
- Department of Nephrology and Transplantation, Skåne University Hospital, Malmö, Sweden
| | - Lars Wennberg
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Ingela Fehrman Ekholm
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| |
Collapse
|
11
|
Moi L, Faurschou M, Hauser T, Bajema I, Luqmani R, Mahr A, Jayne D, Höglund P, Westman K. 153. THE 10-YEAR LONG-TERM FOLLOW-UP OF PATIENTS WITH ANCA-ASSOCIATED VASCULITIS INCLUDED IN EUROPEAN VASCULITIS SOCIETY RANDOMISED CLINICAL TRIALS SINCE 1995: A SURVIVAL ANALYSIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura Moi
- CHUV, Service d’Immunologie et Allergie Lausanne, Switzerland
| | | | | | | | | | | | - David Jayne
- University of Cambridge Addenbrookes Hospital Cambridge, United Kingdom
| | | | | |
Collapse
|
12
|
Erdbrügger U, Kielstein JT, Westman K, Ma JZ, Xin W, Bode-Böger SM, Segelmark M, Rasmussen N, De Groot K. Higher levels of SDMA and not ADMA are associated with poorer survival of trial patients with systemic ANCA-associated vasculitis. Eur J Rheumatol 2018; 5:153-159. [PMID: 30071927 DOI: 10.5152/eurjrheum.2018.17119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Endothelial dysfunction, increased cardiovascular events (CVE), and accelerated atherosclerosis have been described in patients with small vessel vasculitis and collagen vascular disease. Identifying predictors of cardiovascular risk will help to optimize short- and long-term care of patients with vasculitis. The present study investigates the predictive role of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA) and its stereoisomer symmetric dimethylarginine (SDMA) for cardiovascular risk, all-cause mortality, and renal function in patients with anti-neutrophil-cytoplasmic antibodies-associated small vessel vasculitis (AASV) subjected to standardized treatment regimens in four European Vasculitis Study Group trials representing all stages of renal disease. METHODS Sera from 89 patients with AASV were available for measuring SDMA, ADMA, and arginine using liquid chromatography/mass spectrometry at the time of active disease and remission. Clinical data on disease activity, remission, relapse rate, and 5-year follow-up data for CVE and renal outcome were collected. RESULTS Symmetric dimethylarginine and ADMA levels were not predictive of CVE at 5 years of follow-up. The overall CVE rate was low in the present cohort of AASV (8%). However, SDMA, and not ADMA, levels were significantly associated with poorer survival (death/ESRD) independent of entry glomerular filtration rate. CONCLUSION This novel outcome in a well-defined group of patients with AASV might indicate a different mechanism of endothelial response in AASV as compared with atherosclerosis. This should be further explored in a larger cohort of AASV patients with a higher CVE rate and/or a longer follow-up. Moreover, these findings should be correlated to other markers of vascular damage.
Collapse
Affiliation(s)
- Uta Erdbrügger
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Virginia, USA
| | - Jan T Kielstein
- Department of Hypertension and Nephrology, Medical Clinic V, Klinikum Braunschweig, Braunschweig, Germany
| | | | - Jennie Z Ma
- Department of Biostatistics, University of Virginia Health System, Virginia, USA
| | - Wenjun Xin
- Department of Biostatistics, University of Virginia Health System, Virginia, USA
| | | | - Mȧrten Segelmark
- Division of Drug Research, Department of Medical Health Sciences, Linköping University, Linköping, Sweden
| | - Niels Rasmussen
- Department of Biochemistry and Immunology, Statens Seruminstitut, Copenhagen, Denmark
| | - Kirsten De Groot
- Department of Nephrology and Rheumatology, Medical Clinic III, Sana Klinikum, Offenbach, Germany
| |
Collapse
|
13
|
de Joode AAE, Sanders JSF, Puéchal X, Guillevin LP, Hiemstra TF, Flossmann O, Rasmussen N, Westman K, Jayne DR, Stegeman CA. Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data. Rheumatology (Oxford) 2017; 56:1894-1901. [PMID: 28977502 DOI: 10.1093/rheumatology/kex281] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 11/14/2022] Open
Abstract
Objective We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Methods Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. Results During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Conclusion Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
Collapse
Affiliation(s)
- Anoek A E de Joode
- Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Stephan F Sanders
- Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Loic P Guillevin
- National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, University Paris-Descartes, Paris, France
| | - Thomas F Hiemstra
- Department of Internal Medicine, Experimental Medicine and Immunotherapeutics, University of Cambridge and Lupus and Vasculitis Unit, Cambridge
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Berkshire, UK
| | - Nils Rasmussen
- Department of Ear, Nose and Throat, Rigshospitalet, Copenhagen, Denmark
| | - Kerstin Westman
- Department of Nephrology and Transplantation, Lund University Hospital, Malmö, Sweden
| | - David R Jayne
- Department of Internal Medicine and Nephrology, University of Cambridge and Lupus and Vasculitis Unit, Cambridge, UK
| | - Coen A Stegeman
- Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
14
|
Kronbichler A, Leierer J, Leierer G, Mayer G, Casian A, Höglund P, Westman K, Jayne D. Clinical associations with venous thromboembolism in anti-neutrophil cytoplasm antibody-associated vasculitides. Rheumatology (Oxford) 2017; 56:704-708. [PMID: 28053275 DOI: 10.1093/rheumatology/kew465] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 12/24/2022] Open
Abstract
Objective To assess potential associations for the development of venous thromboembolic events in patients with ANCA-associated vasculitides (AAV). Methods Four hundred and seventeen patients enrolled to participate in randomized controlled trials conducted by the European Vasculitis Society were identified. Univariate and multivariate analyses were performed to validate previously proposed and identify novel risks associated with venous thromboembolism (VTE) in AAV. Results VTE occurred in 41 of 417 (9.8%) patients. Uncorrected univariate analysis identified BVAS (odds ratio, OR = 1.05, 95% CI: 1.01, 1.10; P = 0.013), subsequent development of malignancy (OR = 2.6, 95% CI: 1.19, 5.71; P = 0.017), mucous membrane or eye involvement (OR = 2.13, 95% CI: 1.10, 4.11; P = 0.024) and baseline creatinine (OR = 1.08, 95% CI: 0.99, 1.18; P = 0.037) as being associated with the development of VTE. Multivariate analysis highlighted CRP (per 10 mg/l increase, OR = 1.05, 95% CI: 1.01, 1.09; P = 0.025), cutaneous involvement (OR = 4.83, 95% CI: 1.63, 14.38; P = 0.005) and gastrointestinal involvement (OR = 6.27, 95% CI: 1.34, 29.37; P = 0.02) among the BVAS items as well as baseline creatinine (per 100 µmol/l increase, OR = 1.17, 95% CI: 1.02, 1.35; P = 0.029) as being associated with VTEs. Conclusion Our results highlight a role of CRP, baseline creatinine, and cutaneous and gastrointestinal involvement in the risk stratification as being associated with thromboembolic events. Moreover, there might be an association between VTEs and subsequent development of malignancy and disease activity in general.
Collapse
Affiliation(s)
- Andreas Kronbichler
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.,Department of Internal Medicine IV (Nephrology and Hypertension)
| | - Johannes Leierer
- Department of Internal Medicine IV (Nephrology and Hypertension)
| | - Gisela Leierer
- Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gert Mayer
- Department of Dermatology and Venereology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alina Casian
- Guy's Hospital, Louise Coote Lupus Unit, London, UK
| | - Peter Höglund
- Competence Centre for Clinical Research, Skane University Hospital, Lund
| | - Kerstin Westman
- Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - David Jayne
- Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | | |
Collapse
|
15
|
Mohammad AJ, Segelmark M, Smith R, Englund M, Nilsson JÅ, Westman K, Merkel PA, Jayne DRW. Severe Infection in Antineutrophil Cytoplasmic Antibody-associated Vasculitis. J Rheumatol 2017; 44:1468-1475. [PMID: 28765251 DOI: 10.3899/jrheum.160909] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the rate of severe infections after the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with the rate in the background population, and to identify predictors of severe infections among patients with AAV. METHODS The study cohort was 186 patients with AAV diagnosed from 1998 to 2010, consisting of all known cases in a defined population in southern Sweden. For each patient, 4 age-and sex-matched reference subjects were randomly chosen from the background population. Using the Skåne Healthcare Register, all International Classification of Diseases codes of infections assigned from 1998 to 2011 were identified. Severe infections were defined as infectious episodes requiring hospitalization. Rate ratios were calculated by dividing the rate in AAV by the rate among the reference subjects. RESULTS The rate ratio for all severe infections was 4.53 (95% CI 3.39-6.00). The highest rate ratios were found for upper respiratory tract: 8.88 (3.54-25.9), Clostridium difficile: 5.35 (1.54-23.8), nonspecific septicemia 4.55 (1.60-13.8), and skin 5.35 (1.69-19.8). Of the severe infections, 38.4% occurred within 6 months of diagnosis, 30.2% from 7-24 months, and 31.4% after 24 months. High serum creatinine and older age at diagnosis were associated with severe infection (p < 0.001). Of those with severe infection, 46.5% died during followup compared to 26% of patients without severe infection (p = 0.004). CONCLUSION Patients with AAV have markedly higher rates of severe infection compared with the background population, especially patients with older age and impaired renal function. The risk of severe infection is particularly high in the first 6 months following the diagnosis of vasculitis.
Collapse
Affiliation(s)
- Aladdin J Mohammad
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. .,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital.
| | - Mårten Segelmark
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Rona Smith
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Martin Englund
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Jan-Åke Nilsson
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Kerstin Westman
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - Peter A Merkel
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| | - David R W Jayne
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopedics, Clinical Epidemiology Unit, and Section of Nephrology, Lund; Department of Medicine and Nephrology, Linköping University, Linköping, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,A.J. Mohammad, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Segelmark, MD, PhD, Department of Medicine and Nephrology, Linköping University; R. Smith, MA, Vasculitis and Lupus Clinic, Addenbrooke's Hospital; M. Englund, MD, PhD, Lund University, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; J.Å. Nilsson, BSc, Lund University, Department of Clinical Sciences Lund, Section of Rheumatology; K. Westman, MD, PhD, Lund University, Department of Clinical Sciences Lund, Section of Nephrology; P.A. Merkel, MD, MPH, Penn Vasculitis Center, Division of Rheumatology and Department of Biostatistics and Epidemiology, University of Pennsylvania; D.R. Jayne, FMedSci, Vasculitis and Lupus Clinic, Addenbrooke's Hospital
| |
Collapse
|
16
|
Heijl C, Mohammad AJ, Westman K, Höglund P. Long-term patient survival in a Swedish population-based cohort of patients with ANCA-associated vasculitis. RMD Open 2017; 3:e000435. [PMID: 28955485 PMCID: PMC5604606 DOI: 10.1136/rmdopen-2017-000435] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Patients with antineutrophil cytoplasmatic antibodies-associated vasculitides (AAV) exhibit higher mortality than the general population. In the current study, we assessed whether cluster affiliation based on clinical presentation might predict mortality. METHODS With case record review, the outcomes for a population-based cohort of patients diagnosed with AAV in southern Sweden (catchment area of 0.7 million inhabitants) between 1997 and 2010 were assessed. Based on organ involvement at presentation, the cohort was stratified into the following clusters: gastrointestinal, cardiovascular, non-renal, renal with proteinase 3 (PR3) and renal without PR3. Cluster affiliation, demographics, clinical and laboratory values at entry were tested as prognostic factors for survival in multivariable models. RESULTS 195 patients (98 female) with a median age of 69 years (IQR 55-77) at diagnosis were included in the cohort. The median time of follow-up was 4 years for the 98 patients (50%) who died during follow-up and 11 years for those alive at end of follow-up. The 1-year, 2-year, 5-year and 10-year survival was 87%, 82%, 70% and 55%, respectively. Prognostic factors for survival were sex, age, renal function and cluster affiliation. The mortality of patients with AAV was significantly increased compared with the general population except in the non-renal cluster. The cardiovascular and gastrointestinal clusters showed the highest mortality. CONCLUSION Even though the mortality in patients with AAV is increased compared with the general population this does not apply to patients without gastrointestinal, cardiovascular or renal involvement at diagnosis. We suggest that the initial clinical presentation is an important predictor for survival.
Collapse
Affiliation(s)
- Caroline Heijl
- Department of Clinical Sciences Lund, Division of Nephrology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden and Department of Renal Medicine, Vasculitis and lupus Clinic, Addenbrooke’s Hospital, Cambridge, UK
| | - Kerstin Westman
- Department of Clinical Sciences Lund, Division of Nephrology, Lund University, Lund, Sweden
| | - Peter Höglund
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
| |
Collapse
|
17
|
Morgan MD, Szeto M, Walsh M, Jayne D, Westman K, Rasmussen N, Hiemstra TF, Flossmann O, Berden A, Höglund P, Harper L. Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse. Arthritis Res Ther 2017; 19:129. [PMID: 28592297 PMCID: PMC5461828 DOI: 10.1186/s13075-017-1321-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 05/09/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Relapse of disease is frequent in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). It is unclear whether persistent ANCA when starting maintenance therapy increases the risk of relapse. We examined the association between ANCA status and relapse in two randomised controlled trials. METHODS ANCA-positive patients in two trials, CYCLOPS and IMPROVE, were switched from cyclophosphamide to maintenance therapy after achieving clinical remission. We classified patients as being either ANCA-positive or ANCA-negative at the time they started maintenance therapy. We compared the risk of relapse in ANCA-positive and ANCA-negative patients. RESULTS Of 252 patients included, 102 (40%) experienced at least one relapse during the follow-up period. At the time of the switch from induction to maintenance therapy, 111 were ANCA-positive, of whom 55 (50%) relapsed, compared to 141 patients who were ANCA-negative, of whom 47 (33%) relapsed. In multivariable time-to-event analysis, a reduced risk of relapse was associated with having become ANCA-negative at the time of switching to maintenance therapy (hazard ratio 0.63, 95% confidence interval 0.42-0.95; p = 0.026). In addition, initial proteinase 3 (PR3)-ANCA, younger age, lower serum creatinine, pulsed cyclophosphamide for remission induction, and mycophenolate mofetil for remission maintenance were all associated with an increased risk of relapse. CONCLUSIONS Becoming ANCA-negative before the switch to maintenance is associated with a reduced risk of relapse. TRIAL REGISTRATION CYCLOPS: ClinicalTrials.gov, NCT00430105 . Registered retrospectively on 31 January 2007. IMPROVE ClinicalTrials.gov, NCT00307645 . Registered retrospectively on 27 March 2006.
Collapse
Affiliation(s)
- Matthew David Morgan
- Renal Immunobiology, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Queen Elizabeth Hospital Birmingham, Area 5, Level 7, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
| | - Matthew Szeto
- Renal Immunobiology, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Michael Walsh
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada
| | - David Jayne
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Kerstin Westman
- Department of Nephrology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Niels Rasmussen
- Department of Autoimmune Serology, Statens Seruminstitut, Copenhagen, Denmark
| | - Thomas F Hiemstra
- School of Clinical Medicine, University of Cambridge and Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | - Annelies Berden
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Höglund
- Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden
| | - Lorraine Harper
- Renal Immunobiology, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | |
Collapse
|
18
|
Weiner M, Goh SM, Mohammad AJ, Hruskova Z, Tanna A, Sharp P, Kang A, Bruchfeld A, Selga D, Chocova Z, Westman K, Eriksson P, Harper L, Pusey CD, Tesaŕ V, Salama AD, Segelmark M. WS7_1 Organ Damage and Hospitalization in Elderly Patients with Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Yates M, Watts RA, Bajema IM, Cid MC, Crestani B, Hauser T, Hellmich B, Holle JU, Laudien M, Little MA, Luqmani RA, Mahr A, Merkel PA, Mills J, Mooney J, Segelmark M, Tesar V, Westman K, Vaglio A, Yalçındağ N, Jayne DR, Mukhtyar C. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis 2016; 75:1583-94. [PMID: 27338776 DOI: 10.1136/annrheumdis-2016-209133] [Citation(s) in RCA: 718] [Impact Index Per Article: 89.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/27/2016] [Indexed: 12/13/2022]
Abstract
In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations.
Collapse
Affiliation(s)
- M Yates
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK Norwich Medical School, University of East Anglia, Norwich, UK
| | - R A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK Department of Rheumatology, Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - I M Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - M C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - B Crestani
- Assistance Publique-Hôpitaux de Paris, Department of Pulmonology, Bichat-Claude Bernard University Hospital, Paris, France
| | - T Hauser
- Immunologie-Zentrum Zürich, Zürich, Switzerland
| | - B Hellmich
- Vaskulits-Zentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Kreiskliniken Esslingen, Kirchheim-Teck, Germany
| | - J U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - M Laudien
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Kiel, Germany
| | - M A Little
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin, Ireland
| | - R A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - A Mahr
- Department of Internal Medicine, Hôpital Saint-Louis, Université Paris 7 René Diderot, Paris, France
| | - P A Merkel
- Division of Rheumatology and the Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Mills
- Vasculitis UK, West Bank House, Winster, Matlock, UK
| | - J Mooney
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - M Segelmark
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Nephrology, Linköping University, Linköping, Sweden
| | - V Tesar
- Department of Nephrology, 1st School of Medicine, Charles University, Prague, Czech Republic
| | - K Westman
- Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden
| | - A Vaglio
- Nephrology Unit, University Hospital of Parma, Parma, Italy
| | - N Yalçındağ
- Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey
| | - D R Jayne
- Lupus and Vasculitis Unit, Addenbrooke's Hospital, Cambridge, UK
| | - C Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
20
|
Yates M, Watts R, Bajema I, Cid M, Crestani B, Hauser T, Hellmich B, Holle J, Laudien M, Little M, Luqmani R, Mahr A, Merkel P, Mills J, Mooney J, Segelmark M, Tesar V, Westman K, Vaglio A, Yalçındağ N, Jayne D, Mukhtyar C. OP0053 Eular/ERA-EDTA Recommendations for The Management of Anca-Associated Vasculitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
Westman K. [The Swedish Society of Nephrology: Microscopic hematuria - no useless finding]. Lakartidningen 2016; 113:D3LS. [PMID: 27164474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
22
|
Kronbichler A, Leierer J, Leierer G, Mayer G, Casian A, Höglund P, Westman K, Jayne D. TO039RISK OF VENOUS THROMBOEMBOLIC EVENTS IN ANCA ASSOCIATED VASCULITIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw150.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
23
|
Yates M, Watts R, Nilüfer N, Bajema I, Little M, Segelmark M, Tesar V, Westman K, Vaglio A, Mooney J, Cid M, Crestani B, Hauser T, Hellmich B, Holle J, Laudien M, Luqmani R, Mahr A, Merkel P, Mills J, Jayne D, Mukhtyar CM. SP143EULAR/ERA-EDTA RECOMMENDATIONS FOR THE MANAGEMENT OF ANCA-ASSOCIATED VASCULITIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw160.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Malmgren L, McGuigan FE, Berglundh S, Westman K, Christensson A, Åkesson K. Declining Estimated Glomerular Filtration Rate and Its Association with Mortality and Comorbidity Over 10 Years in Elderly Women. Nephron Clin Pract 2015; 130:245-55. [DOI: 10.1159/000435790] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022] Open
|
25
|
Weiner M, Goh SM, Mohammad AJ, Hruskova Z, Tanna A, Bruchfeld A, Selga D, Chocova Z, Westman K, Eriksson P, Pusey CD, Tesar V, Salama AD, Segelmark M. Outcome and treatment of elderly patients with ANCA-associated vasculitis. Clin J Am Soc Nephrol 2015; 10:1128-35. [PMID: 26100457 DOI: 10.2215/cjn.00480115] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES ANCA-associated vasculitis is commonly found in elderly patients, but there are few data concerning outcome and treatment in the highest age groups. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Consecutive patients (N=151) presenting between 1997 and 2009 were retrospectively included from local registries in six centers in Sweden, the United Kingdom, and the Czech Republic if diagnosed with microscopic polyangiitis or granulomatosis with polyangiitis at age ≥75 years during the study period. Patients were followed until 2 years from diagnosis or death. Data on survival and renal function were analyzed with respect to age, sex, ANCA specificity, renal function, C-reactive protein, comorbidities, and Birmingham Vasculitis Activity Score at diagnosis as well as treatment during the first month. RESULTS Median follow-up was 730 days (interquartile range, 244-730). Overall 1-year survival was 71.5% and 2-year survival was 64.6%. Older age, higher creatinine, and lower Birmingham Vasculitis Activity Score were associated with higher mortality in multivariable analysis. Patients who were not treated with standard immunosuppressive therapy had significantly worse survival. Renal survival was 74.8% at 1 year. No new cases of ESRD occurred during the second year. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis. CONCLUSIONS ANCA-associated vasculitis is a disease with substantial mortality and morbidity among elderly patients. This study showed a better prognosis for those who received immunosuppressive treatment and those who were diagnosed before having developed advanced renal insufficiency.
Collapse
Affiliation(s)
- Maria Weiner
- Departments of Nephrology and Medical and Health Sciences and
| | - Su Mein Goh
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Zdenka Hruskova
- Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Anisha Tanna
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Annette Bruchfeld
- Department of Renal Medicine, Karolinska University Hospital, and Department of Clinical Sciences, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; and
| | - Daina Selga
- Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden
| | - Zdenka Chocova
- Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Kerstin Westman
- Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö, Sweden
| | - Per Eriksson
- Rheumatology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Charles D Pusey
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Alan D Salama
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
| | | |
Collapse
|
26
|
Karpman D, Fehrman-Ekholm I, Bárány P, Békássy Z, Brandström P, Bruchfeld A, Celsi G, Chromek M, Clyne N, Fellström B, Hansson S, Haraldsson B, Nevéus T, Rippe B, Sartz L, Segelmark M, Stegmayr B, Stenvinkel P, Westman K. [The council for new therapies should immediately revoke their decision on eculizumab]. Lakartidningen 2015; 112:DI7D. [PMID: 26079588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
27
|
Karpman D, Fehrman-Ekholm I, Bárány P, Békássy Z, Brandström P, Bruchfeld A, Celsi G, Chromek M, Clyne N, Fellström B, Hansson S, Haraldsson B, Nevéus T, Rippe B, Sartz L, Segelmark M, Stegmayr B, Stenvinkel P, Tufveson G, Westman K. [The council for new therapies position on eculizumab is unacceptable]. Lakartidningen 2015; 112:DI3F. [PMID: 26057644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
28
|
Jones RB, Furuta S, Tervaert JWC, Hauser T, Luqmani R, Morgan MD, Peh CA, Savage CO, Segelmark M, Tesar V, van Paassen P, Walsh M, Westman K, Jayne DR. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis: 2-year results of a randomised trial. Ann Rheum Dis 2015; 74:1178-82. [PMID: 25739829 DOI: 10.1136/annrheumdis-2014-206404] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/08/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The RITUXVAS trial reported similar remission induction rates and safety between rituximab and cyclophosphamide based regimens for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis at 12 months; however, immunosuppression maintenance requirements and longer-term outcomes after rituximab in ANCA-associated renal vasculitis are unknown. METHODS Forty-four patients with newly diagnosed ANCA-associated vasculitis and renal involvement were randomised, 3:1, to glucocorticoids plus either rituximab (375 mg/m(2)/week×4) with two intravenous cyclophosphamide pulses (n=33, rituximab group), or intravenous cyclophosphamide for 3-6 months followed by azathioprine (n=11, control group). RESULTS The primary end point at 24 months was a composite of death, end-stage renal disease and relapse, which occurred in 14/33 in the rituximab group (42%) and 4/11 in the control group (36%) (p=1.00). After remission induction treatment all patients in the rituximab group achieved complete B cell depletion and during subsequent follow-up, 23/33 (70%) had B cell return. Relapses occurred in seven in the rituximab group (21%) and two in the control group (18%) (p=1.00). All relapses in the rituximab group occurred after B cell return. CONCLUSIONS At 24 months, rates of the composite outcome of death, end-stage renal disease and relapse did not differ between groups. In the rituximab group, B cell return was associated with relapse. TRIAL REGISTRATION NUMBER ISRCTN28528813.
Collapse
Affiliation(s)
| | | | | | | | - Raashid Luqmani
- Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
| | - Matthew D Morgan
- Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Chen Au Peh
- Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia
| | - Caroline O Savage
- Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marten Segelmark
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Vladimir Tesar
- The First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pieter van Paassen
- Clinical and Experimental Immunology, Maastricht University, Maastricht, The Netherlands
| | - Michael Walsh
- Departments of Medicine (Nephrology) and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | - Kerstin Westman
- Department of Nephrology and Transplantation in Malmo, University Hospital of Skane and Lund University, Malmo, Sweden
| | | | | |
Collapse
|
29
|
Pagnoux C, Carette S, Khalidi NA, Walsh M, Hiemstra TF, Cuthbertson D, Langford C, Hoffman GS, Koening CL, Monach PA, Moreland L, Mouthon L, Seo P, Specks U, Ytterberg S, Westman K, Hoglund P, Harper L, Flossmann O, Luqmani R, Savage C, Rasmussen N, de Groot K, Tesar V, Jayne D, Merkel PA, Guillevin L. Comparability of patients with ANCA-associated vasculitis enrolled in clinical trials or in observational cohorts. Clin Exp Rheumatol 2015; 33:S-83. [PMID: 26016754 PMCID: PMC4525702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To analyse the differences between patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) entered into randomised clinical trials (RCTs) and those followed in large observational cohorts. METHODS The main characteristics and outcomes of patients with generalised and/or severe GPA or MPA with a five-factor score ≥ 1 enrolled in the French Vasculitis Study Group (FVSG) or the US-Canadian-based Vasculitis Clinical Research Consortium cohorts were compared to those enrolled in one of 2 FVSG clinical RCTs (WEG91, WEGENT) or 3 European Vasculitis Society clinical trials (CYCLOPS, CYCAZAREM, IMPROVE). RESULTS 657 patients (65.3% with GPA) in RCTs were compared to 437 in cohorts (90.6% with GPA). RCT patients were older at diagnosis than the cohort patients (56.6 ± 13.9 vs. 46.8 ± 17.3 years), had higher Birmingham vasculitis activity score (19.5 ± 9.1 vs. 16.9 ± 7.4), and more frequent kidney disease (84.0% vs. 54.9%) but fewer ear, nose, and throat symptoms (56.8% vs. 72.2%). At 56 months post-diagnosis, mortality and relapse rates, adjusted for age and renal function, were higher for patients with GPA in RCTs vs. cohorts (10.7% vs. 2.5% [p=0.001] and 22.5% vs. 15.6% [p=0.03], respectively) but similar for patients with MPA (6.2% vs. 6.6% [p=0.92] and 16.6% vs. 10.1% [p=0.39], respectively). CONCLUSIONS Patients with GPA or MPA in RCTs and those in observational cohorts show important differences that should be remembered when interpreting results based on these study populations.
Collapse
Affiliation(s)
- Christian Pagnoux
- Division of Rheumatology, University of Toronto, Toronto, Canada
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
| | - Simon Carette
- Division of Rheumatology, University of Toronto, Toronto, Canada
| | | | - Michael Walsh
- Division of Nephrology and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Thomas F. Hiemstra
- University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, UK
| | - David Cuthbertson
- Department of Biostatistics, University of South Florida, Tampa, USA
| | | | | | - Curry L. Koening
- Division of Rheumatology, University of Utah, Salt Lake City, USA
| | | | - Larry Moreland
- Vasculitis Center, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
| | - Phil Seo
- Boston University Vasculitis Center, Boston, USA
| | - Ulrich Specks
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | | | - Kerstin Westman
- Department of Nephrology and Transplantation, Lund University, Skane University Hospital Malmö, Sweden
| | - Peter Hoglund
- Competence Centre for Clinical Research, Skane University, Lund, Sweden
| | - Lorraine Harper
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Oliver Flossmann
- Department of Nephrology, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Raashid Luqmani
- Department of Nephrology, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK
| | - Caroline Savage
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Niels Rasmussen
- Department of Ear, Nose and Throat, Rigshospitalet, Copenhagen, Denmark
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University and General University Hospital First Faculty of Medicine, Prague, Czech Republic
| | - David Jayne
- University of Cambridge and Lupus and Vasculitis Unit, Addenbrookes Hospital, Cambridge, UK
| | - Pater A. Merkel
- Vasculitis Center, Division of Rheumatology, University of Pennsylvania, Philadelphia, USA
| | - Loic Guillevin
- Department of Internal Medicine, National Referral Center for Necrotising Vasculitides and Systemic Sclerosis, Department of Internal Medicine, Hôpital Cochin, University Paris-Descartes, Paris, France
| |
Collapse
|
30
|
Abstract
Patients with generalized ANCA-associated small vessel vasculitis (AAV) have a very poor outcome if the ANCA-associated vasculitis is not diagnosed, evaluated and treated properly. The introduction of treatment with immunosuppressive therapy has improved patient survival dramatically but with considerable side effects. Besides, almost 50% of surviving patients experience a relapse of vasculitis. Since 1995, the European Vasculitis Society (EUVAS) has designed and conducted several clinical trials on patients with AAV independently of pharmaceutical companies. The studies included patients with newly diagnosed AAV and were stratified according to renal function and generalized versus more localized forms. As the immediate patient survival has improved, the longer term outcome has become more important. There are several reports on outcome of patients with ANCA-associated vasculitis, but the patient groups were heterogeneous regarding diagnosis as well as treatment and follow-up. Therefore, EUVAS decided to further evaluate the effect and possible adverse events of the original randomized trials. This review presents an overview on long-term follow-up of patients with ANCA-associated vasculitis, with focus on relapse rate, patient and renal survival and development of cardiovascular disease and malignancy.
Collapse
Affiliation(s)
- Kerstin Westman
- Department of Nephrology, Clinical Sciences, Lund University, Skane University Hospital Malmö, Lund, Sweden
| | | | - Gina Gregorini
- Department of Nephrology, A.O. Spedali Civili, Brescia, Italy
| |
Collapse
|
31
|
Robson J, Doll H, Suppiah R, Flossmann O, Harper L, Höglund P, Jayne D, Mahr A, Westman K, Luqmani R. Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials. Rheumatology (Oxford) 2014; 54:471-81. [PMID: 25205825 DOI: 10.1093/rheumatology/keu366] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Granulomatosis with polyangiitis and microscopic polyangiitis are ANCA-associated vasculitides (AAVs). The Vasculitis Damage Index (VDI) quantifies damage. This study aims to determine the factors associated with long-term damage in the AAVs. METHODS Data from 535 patients from four European Vasculitis Study Group trials were studied. A long-term follow-up (LTFU) questionnaire at 7 years post-diagnosis was completed. The associations between baseline (age, creatinine and BVAS score) and cumulative (number of relapses and duration of glucocorticoid use) factors and damage accrued (total VDI scores and individual treatment-related damage items) during follow-up were explored. Multiple regressions identified independent associations between baseline measures, cumulative factors and VDI scores at LTFU. RESULTS Two hundred and ninety-six patients had glucocorticoid use and VDI data available at LTFU, with the mean length of glucocorticoid use being 40.4 months (S.D. 16.7). High levels of damage were independently associated with older age at baseline (P = 0.051), lower glomerular filtration rate (P = 0.041), higher BVAS scores (P = 0.046), increased cumulative glucocorticoid use (P = 0.016) and increasing number of relapses. Patients with longer duration of glucocorticoid treatment were more likely to have a total VDI score ≥5 [odds ratio 1.26 per 12 months of glucocorticoid use (95% CI 1.03, 1.53), P = 0.022]. The main limitation is that approximately half of the patients enrolled had no LTFU data available; these patients were older with more severe initial disease. CONCLUSION Long-term damage in the AAVs may be associated with severity of initial disease, age, number of relapses and duration of glucocorticoid use.
Collapse
Affiliation(s)
- Joanna Robson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden.
| | - Helen Doll
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Ravi Suppiah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Oliver Flossmann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Lorraine Harper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Peter Höglund
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - David Jayne
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Alfred Mahr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Kerstin Westman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK, Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand, Renal Department, Royal Berkshire NHS Foundation Trust, Reading, Centre for Translational Inflammation Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK, Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden, Renal Department, Addenbrooke's Hospital, Cambridge, UK, Department of Internal Medicine, Hospital Saint-Louis, Paris, France and Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| |
Collapse
|
32
|
Walsh M, Faurschou M, Berden A, Flossmann O, Bajema I, Hoglund P, Smith R, Szpirt W, Westman K, Pusey CD, Jayne DRW. Long-term follow-up of cyclophosphamide compared with azathioprine for initial maintenance therapy in ANCA-associated vasculitis. Clin J Am Soc Nephrol 2014; 9:1571-6. [PMID: 24970876 DOI: 10.2215/cjn.00100114] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment with azathioprine within 3 months of remission induction with cyclophosphamide is a common treatment strategy for patients with ANCA-associated vasculitis. This study comprised patients undergoing long-term follow-up who were randomly allocated to azathioprine after 3-6 months or after 12 months of cyclophosphamide treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients from 39 European centers between 1995 and 1997 with a new diagnosis of ANCA-associated vasculitis that involved the kidneys or another vital organ were eligible. At the time of diagnosis, participants were randomly allocated to convert to azathioprine after 3-6 months (the azathioprine group) or after 12 months of cyclophosphamide (the cyclophosphamide group). Patients who did not achieve a remission within 6 months were excluded. This study assessed relapses, ESRD, and death during long-term follow-up. RESULTS Patients were allocated to the azathioprine group (n=71) and the cyclophosphamide group (n=73). Of these patients, 63 (43.8%) developed a relapse, 35 (24.3%) developed a renal relapse, 13 (9.0%) developed ESRD, and 21 (14.6%) died. Although there were worse outcomes in the azathioprine group, none were statistically significant. The subdistribution hazard ratio [sHR] for relapse was 1.63 (95% confidence interval [95% CI], 0.99 to 2.71), the composite of relapse or death hazard ratio [HR] was 1.59 (95% CI, 1.00 to 2.54), the ESRD sHR was 1.71 (95% CI, 0.56 to 5.19), and the death HR was 0.75 (95% CI, 0.32 to 1.79). CONCLUSIONS It remains uncertain whether converting to azathioprine after 3-6 months of induction cyclophosphamide therapy is as effective as converting after 12 months. Outcomes are still poor for this group of patients and further research is required to determine the optimal timing of maintenance therapy.
Collapse
Affiliation(s)
- Michael Walsh
- Departments of Medicine and Clinical Epidemiology and Biostatistics, Population Health Research Institute, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada;
| | | | - Annelies Berden
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ingeborg Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Hoglund
- Competence Centre for Clinical Research, University Hospital Lund, Lund, Sweden
| | - Rona Smith
- Renal Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Wladimir Szpirt
- Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kerstin Westman
- Department of Nephrology and Transplantation, Skane University Hospital, Malmö, Sweden; and
| | - Charles D Pusey
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - David R W Jayne
- Renal Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | | |
Collapse
|
33
|
Furuta S, Chaudhry AN, Hamano Y, Fujimoto S, Nagafuchi H, Makino H, Matsuo S, Ozaki S, Endo T, Muso E, Ito C, Kusano E, Yamagata M, Ikeda K, Kashiwakuma D, Iwamoto I, Westman K, Jayne D. Comparison of phenotype and outcome in microscopic polyangiitis between Europe and Japan. J Rheumatol 2014; 41:325-33. [PMID: 24429174 DOI: 10.3899/jrheum.130602] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are differences between Europe and Japan in the incidence and antineutrophil cytoplasmic antibody (ANCA) serotype of patients with microscopic polyangiitis (MPA). However, differences in phenotype or outcome have not been explored. We aimed to identify differences in phenotype and outcome of MPA between Europe and Japan. METHODS Sequential cohorts of patients with MPA and renal limited vasculitis were collected from European and Japanese centers (n = 147 and n = 312, respectively). Trial databases from the European Vasculitis Society and the Japanese patients with Myeloperoxidase (MPO)-ANCA-Associated Vasculitis (JMAAV) trial were studied (n = 254 and n = 48, respectively). We evaluated baseline characteristics including ANCA status and organ involvement, treatment, survival, and renal survival. Differences in survival and renal survival were studied using multivariate analysis. RESULTS The non-trial cohorts showed patients with MPA in Japan had a higher age at onset, more frequent MPO-ANCA positivity, lower serum creatinine, and more frequent interstitial pneumonitis than those in Europe (all p < 0.01). Comparisons between the trial databases demonstrated similar results. Cumulative patient survival and renal survival rates were not different between Europe and Japan (p = 0.71 and p = 0.38, respectively). Multivariate analysis identified age at onset, serum creatinine, gastrointestinal, and respiratory involvement as factors with higher risk of death. For endstage renal failure, serum creatinine and use of plasma exchange were identified as factors with higher risk, and immunosuppressant use as lower risk factors. CONCLUSION Phenotypes in patients with MPA were different between Europe and Japan. However, the outcomes of patient survival and renal survival were similar.
Collapse
Affiliation(s)
- Shunsuke Furuta
- From the Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK; Department of Nephrology, Tokyo Metropolitan Geriatric Hospital, Tokyo; Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki; Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki; Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama; Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya; Division of Nephrology and Dialysis, Department of Medicine, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Osaka; Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi; Department of Allergy and Clinical Immunology, Chiba University Hospital; Department of Allergy and Clinical Immunology, Asahi General Hospital, Chiba, Japan; Department of Nephrology and Transplantation, Skane University Hospital, Malmö, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Robson J, Doll H, Suppiah R, Flossmann O, Harper L, Höglund P, Jayne D, Mahr A, Westman K, Luqmani R. Damage in the anca-associated vasculitides: long-term data from the European vasculitis study group (EUVAS) therapeutic trials. Ann Rheum Dis 2013; 74:177-84. [PMID: 24243925 DOI: 10.1136/annrheumdis-2013-203927] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe short-term (up to 12 months) and long-term (up to 7 years) damage in patients with newly diagnosed antineutrophil-cytoplasm antibody-associated vasculitis (AAV). METHODS Data were combined from six European Vasculitis Study group trials (n=735). Long-term follow-up (LTFU) data available for patients from four trials (n=535). Damage accrued was quantified by the Vasculitis Damage Index (VDI). Sixteen damage items were defined a priori as being potentially treatment-related. RESULTS VDI data were available for 629 of 735 patients (85.6%) at baseline, at which time 217/629 (34.5%) had ≥1 item of damage and 32 (5.1%) ≥5 items, reflecting disease manifestations prior to diagnosis and trial enrolment. LTFU data were available for 467/535 (87.3%) at a mean of 7.3 years postdiagnosis. 302/535 patients (56.4%) had VDI data at LTFU, with 104/302 (34.4%) having ≥5 items and only 24 (7.9%) no items of damage. At 6 months and LTFU, the most frequent items were proteinuria, impaired glomerular filtration rate, hypertension, nasal crusting, hearing loss and peripheral neuropathy. The frequency of damage, including potentially treatment-related damage, rose over time (p<0.01). At LTFU, the most commonly reported items of treatment-related damage were hypertension (41.5%; 95% CI 35.6 to 47.4%), osteoporosis (14.1%; 9.9 to 18.2%), malignancy (12.6%; 8.6 to 16.6%), and diabetes (10.4%; 6.7 to 14.0%). CONCLUSIONS In AAV, renal, otolaryngological and treatment-related (cardiovascular, disease, diabetes, osteoporosis and malignancy) damage increases over time, with around one-third of patients having ≥5 items of damage at a mean of 7 years postdiagnosis.
Collapse
Affiliation(s)
- Joanna Robson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, USA Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, UK
| | - Helen Doll
- Department of Population Health, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Ravi Suppiah
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Oliver Flossmann
- Renal Department, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Lorraine Harper
- School of Immunity and Infection, Centre for Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Peter Höglund
- Competence Centre for Clinical Research, Skane University Hospital, Lund, Sweden
| | - David Jayne
- Renal Department, Addenbrooke's Hospital, Cambridge, UK
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, Paris, France
| | - Kerstin Westman
- Nephrology and Transplantation, Skane University Hospital Malmo, Lund University, Malmo, Sweden
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, USA
| |
Collapse
|
35
|
|
36
|
Gayed M, Leone F, Toescu V, Bruce I, Giles I, Teh LS, McHugh N, Edwards C, Akil M, Khamashta M, Gordon C, Parker B, Urowitz M, Gladman D, Lunt M, Bruce I, Redmond A, Alcacer-Pitarch B, Gray J, Denton C, Herrick A, Navarro-Coy N, Collier H, Loughrey L, Pavitt S, Siddle H, Wright J, Helliwell P, Emery P, Buch M, Abrol E, Pulido CG, Isenberg DA, Kia S, Patil P, Williams M, Adizie T, Christidis D, Gordon T, Borg FA, Jain S, Dasgupta B, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Al-Mossawi MH, Ridley A, Wong I, Kollnberger S, Shaw J, Bowness P, Di Cicco M, Humby F, Kelly S, Ng N, Hands R, Dadoun S, Buckley C, McInnes IB, Taylor P, Bombardieri M, Pitzalis C, Mansour S, Tocheva A, Goulston L, Platten H, Edwards C, Cooper C, Gadola SD, Lugli E, Lundberg K, Bracke K, Brusselle G, Venables PJ, Sanchez-Blanco C, Cornish G, Burn G, Saini M, Brownlie R, Klavinskis L, Williams R, Thompson S, Svensson L, Zamoyska R, Cope A, Hong CF, Khan K, Alade R, Nihtyanova SI, Ong VH, Denton CP, Scott DL, Ibrahim F, Kelly C, Birrell F, Chakravarty K, Walker D, Maddison P, Kingsley G, Cohen C, Karaderi T, Appleton L, Keidel S, Pointon J, Ridley A, Bowness P, Wordsworth P, Williams MA, Heine PJ, McConkey C, Lord J, Dosanjh S, Williamson E, Adams J, Underwood M, Lamb SE. Oral Abstracts 1: Connective Tissue Disease * O1. Long-Term Outcomes of Children Born to Mothers with SLE. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Karrar S, Shiwen X, Nikotorowicz-Buniak J, Abraham DJ, Denton C, Stratton R, Bayley R, Kite KA, Clay E, Smith JP, Kitas GD, Buckley C, Young SP, Ye L, Zhang L, Goodall J, Gaston H, Xu H, Lutalo PM, Zhao Y, Meng Choong L, Sangle S, Spencer J, D'Cruz D, Rysnik OJ, McHugh K, Bowness P, Rump-Goodrich L, Mattey D, Kehoe O, Middleton J, Cartwright A, Schmutz C, Askari A, Middleton J, Gardner DH, Jeffery LE, Raza K, Sansom DM, Clay E, Bayley R, Fitzpatrick M, Wallace G, Young S, Shaw J, Hatano H, Cauli A, Giles JL, McHugh K, Mathieu A, Bowness P, Kollnberger S, Webster S, Ellis L, O'Brien LM, Fitzmaurice TJ, Gaston H, Goodall J, Nazeer Moideen A, Evans L, Osgood L, Williams A, Jones S, Thomas C, O'Donnell V, Nowell M, Ouboussad L, Savic S, Dickie LJ, Hintze J, Wong CH, Cook GP, Buch M, Emery P, McDermott MF, Hardcastle SA, Gregson CL, Deere K, Davey Smith G, Dieppe P, Tobias JH, Dennison E, Edwards M, Bennett J, Coggon D, Palmer K, Cooper C, McWilliams D, Young A, Kiely PD, Walsh D, Taylor HJ, Harding I, Hutchinson J, Nelson I, Blom A, Tobias J, Clark E, Parker J, Bukhari M, McWilliams D, Jayakumar K, Young A, Kiely P, Walsh D, Diffin J, Lunt M, Marshall T, Chipping J, Symmons D, Verstappen S, Taylor HJ, Harding I, Hutchinson J, Nelson I, Tobias J, Clark E, Bluett J, Bowes J, Ho P, McHugh N, Buden D, Fitzgerald O, Barton A, Glossop JR, Nixon NB, Emes RD, Dawes PT, Farrell WE, Mattey DL, Scott IC, Steer S, Seegobin S, Hinks AM, Eyre S, Morgan A, Wilson AG, Hocking L, Wordsworth P, Barton A, Worthington J, Cope A, Lewis CM, Guerra S, Ahmed BA, Denton C, Abraham D, Fonseca C, Robinson J, Taylor J, Haroon Rashid L, Flynn E, Eyre S, Worthington J, Barton A, Isaacs J, Bowes J, Wilson AG, Barrett JH, Morgan A, Kingston B, Ahmed M, Kirwan JR, Marshall R, Chapman K, Pearson R, Heycock C, Kelly C, Rynne M, Saravanan V, Hamilton J, Saeed A, Coughlan R, Carey JJ, Farah Z, Matthews W, Bell C, Petford S, Tibbetts LM, Douglas KMJ, Holden W, Ledingham J, Fletcher M, Winfield R, Price Z, Mackay K, Dixon C, Oppong R, Jowett S, Nicholls E, Whitehurst D, Hill S, Hammond A, Hay E, Dziedzic K, Righetti C, Lebmeier M, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Nikiphorou E, Morris S, James D, Kiely P, Walsh D, Young A, Wong EC, Long J, Fletcher A, Fletcher M, Holmes S, Hockey P, Abbas M, Chattopadhyay C, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, Robson J, Kiran A, Maskell J, Arden N, Hutchings A, Emin A, Culliford D, Dasgupta B, Hamilton W, Luqmani R, Jethwa H, Rowczenio D, Trojer H, Russell T, Loeffler J, Hawkins P, Lachmann H, Verma I, Syngle A, Krishan P, Garg N, Flint J, Gayed M, Schreiber K, Arthanari S, Nisar M, Khamashta M, Gordon C, Giles I, McGowan SP, Gerrard DT, Chinoy H, Ollier WE, Cooper RG, Lamb JA, Taborda L, Correia Azevedo P, Isenberg D, Leyland KM, Kiran A, Judge A, Hunter D, Hart D, Javaid MK, Arden N, Cooper C, Edwards MH, Litwic AE, Jameson KA, Deeg D, Cooper C, Dennison E, Edwards MH, Jameson KA, Cushnaghan J, Aihie Sayer A, Deeg D, Cooper C, Dennison E, Jagannath D, Parsons C, Cushnaghan J, Cooper C, Edwards MH, Dennison E, Stoppiello L, Mapp P, Ashraf S, Wilson D, Hill R, Scammell B, Walsh D, Wenham C, Shore P, Hodgson R, Grainger A, Aaron J, Hordon L, Conaghan P, Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N, Drexler M, Mor A, Segal G, Lahad A, Haim A, Rath U, Morgensteren DM, Salai M, Elbaz A, Vasishta VG, Derrett-Smith E, Hoyles R, Khan K, Abraham DJ, Denton C, Ezeonyeji A, Takhar G, Denton C, Ong V, Loughrey L, Bissell LA, Hensor E, Abignano G, Redmond A, Buch M, Del Galdo F, Hall FC, Malaviya A, Nisar M, Baker S, Furlong A, Mitchell A, Godfrey AL, Ruddlesden M, Hadjinicolaou A, Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, Roberts C, Herrick A, Denton CP, Guillevin L, Hunsche E, Rosenberg D, Schwierin B, Scott M, Krieg T, Anderson M, Hall FC, Herrick A, McHugh N, Matucci-Cerinic M, Alade R, Khan K, Xu S, Denton C, Ong V, Nihtyanova S, Ong V, Denton CP, Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, Ritchlin C, Li S, Wang Y, Mendelsohn A, Doyle M, Tillett W, Jadon D, Shaddick G, Cavill C, Robinson G, Sengupta R, Korendowych E, de Vries C, McHugh N, Thomas RC, Shuto T, Busquets-Perez N, Marzo-Ortega H, McGonagle D, Tillett W, Richards G, Cavill C, Sengupta R, Shuto T, Marzo-Ortega H, Thomas RC, Bingham S, Coates L, Emery P, John Hamlin P, Adshead R, Cambridge S, Donnelly S, Tahir H, Suppiah P, Cullinan M, Nolan A, Thompson WM, Stebbings S, Mathieson HR, Mackie SL, Bryer D, Buch M, Emery P, Marzo-Ortega H, Krutikov M, Gray L, Bruce E, Ho P, Marzo-Ortega H, Busquets-Perez N, Thomas RC, Gaffney K, Keat A, Innes W, Pandit R, Kay L, Lapshina S, Myasoutova L, Erdes S, Wallis D, Waldron N, McHugh N, Korendowych E, Thorne I, Harris C, Keat A, Garg N, Syngle A, Vohra K, Khinchi D, Verma I, Kaur L, Jones A, Harrison N, Harris D, Jones T, Rees J, Bennett A, Fazal S, Tugnet N, Barkham N, Basu N, McClean A, Harper L, Amft EN, Dhaun N, Luqmani RA, Little MA, Jayne DR, Flossmann O, McLaren J, Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
38
|
Göçeroğlu A, De Lind Van Wijngaarden R, Berden A, Westman K, Flossmann O, Walsh M, Fiocco M, Wolterbeek R, Hauer H, Jayne D, Gaskin G, Rasmussen N, Noël L, Ferrario F, Waldherr R, Pusey C, Hagen E, Bruijn J, Bajema I. Predicting renal relapse with the histopathologic classification of ANCA-associated glomerulonephritis. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
39
|
Weiner M, Goh S, Mohammad A, Hrušková Z, Tanna A, Bruchfeld A, Selga D, Ko Q, Westman K, Eriksson P, Pusey C, Tesar V, Salama A, Segelmark M. Outcome and prognostic factors in elderly patients with ANCA-associated vasculitis. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
40
|
Maldini C, Resche-Rigon M, Jayne D, Westman K, Mahr A. A risk score for predicting short-term incidence of death or relapse in anti-neutrophil cytoplasmic antibody-associated vasculitis. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
41
|
Furuta S, Chaudhry A, Hamano Y, Fujimoto S, Nagafuchi H, Ozaki S, Makino H, Matsuo S, Endo T, Muso E, Ito C, Kusano E, Yamagata M, Ikeda K, Kasiwakuma D, Iwamoto I, Westman K, Jayne D. Comparison of phenotype and outcome in microscopic polyangiitis between Europe and Japan. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
42
|
Faurschou M, Westman K, Rasmussen N, de Groot K, Flossmann O, Höglund P, Jayne DRW. Brief Report: long-term outcome of a randomized clinical trial comparing methotrexate to cyclophosphamide for remission induction in early systemic antineutrophil cytoplasmic antibody-associated vasculitis. ACTA ACUST UNITED AC 2013; 64:3472-7. [PMID: 22614882 DOI: 10.1002/art.34547] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The NORAM (Nonrenal Wegener's Granulomatosis Treated Alternatively with Methotrexate [MTX]) trial demonstrated that MTX can replace cyclophosphamide (CYC) as remission-inducing treatment for patients with newly diagnosed early systemic antineutrophil cytoplasmic antibody-associated vasculitis. Duration of relapse-free survival was longer among CYC-treated patients than among MTX-treated patients during short-term followup. The aim of the present study was to describe the long-term outcome in patients enrolled in the randomized clinical trial. METHODS Outcome questionnaires were sent to investigators who had recruited patients for the NORAM trial. Patients treated with MTX for induction of remission (n = 49) were compared to CYC-treated patients (n = 46) with respect to immunosuppressive therapy during followup, relapse-free survival, mortality, and occurrence of other clinical events. RESULTS The median duration of followup was 6 years (range 0.1-10.8 years). One patient developed end-stage renal disease, and 11 died. The number of patients affected by serious infection, malignancy, or severe organ failure did not differ between treatment groups, and no difference in survival rate was observed. The duration of corticosteroid therapy was longer in the MTX group during the 18 months of the trial (P = 0.005). During subsequent followup, patients who were in the MTX group in the NORAM trial received corticosteroids, CYC, and other immunosuppressive agents (azathioprine, MTX, and/or mycophenolate mofetil) for longer periods than those who were in the CYC group (P = 0.004, P = 0.037, and P = 0.031, respectively). The cumulative relapse-free survival tended to be lower in the MTX group (P = 0.056). CONCLUSION In the NORAM cohort, no difference in occurrence of major adverse events was observed between treatment groups during long-term followup. However, first-line treatment with MTX was associated with less effective disease control than CYC-based induction therapy.
Collapse
Affiliation(s)
- Mikkel Faurschou
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Westman K, Castedal M, Bennet W, Kornhall B. [The transplant patient at the community health center and the emergency department]. Lakartidningen 2012; 109:1762-1765. [PMID: 23097886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kerstin Westman
- Transplantationskliniken, Skånes universitetssjukhus, Malmö.
| | | | | | | |
Collapse
|
44
|
Walsh M, Flossmann O, Berden A, Westman K, Höglund P, Stegeman C, Jayne D. Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. ACTA ACUST UNITED AC 2012; 64:542-8. [PMID: 21953279 DOI: 10.1002/art.33361] [Citation(s) in RCA: 243] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the association between characteristics at diagnosis and the time to first relapse in a large cohort of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS We studied long-term followup data from 4 clinical trials that included newly diagnosed patients with a broad spectrum of AAV severity and manifestations. Patient and disease characteristics at baseline were used in competing risk regression models with relapse as the event of interest and death as the competing event. RESULTS We assessed 535 patients with 1,804 patient-years at risk of relapse. At diagnosis, the median age was 60.7 years (interquartile range [IQR] 48.8-69.1 years), 284 patients (53%) had granulomatosis with polyangiitis (Wegener's), and the median creatinine level was 203 μmoles/liter (IQR 97-498). A total of 201 patients (38%) experienced a relapse and 133 patients (25%) died, 96 of whom had not had prior relapse. Anti-proteinase 3 antibodies (subhazard ratio [sHR] 1.62 [95% confidence interval 1.39-1.89]) and cardiovascular involvement (sHR 1.59 [95% confidence interval 1.07-2.37]) were independently associated with a higher risk of relapse. Compared with patients with a creatinine level ≤100 μmoles/liter, patients with higher creatinine levels had a lower risk of relapse (sHR 0.81 [95% confidence interval 0.77-0.85] for a creatinine level of 101-200 μmoles/liter; sHR 0.39 [95% confidence interval 0.22-0.69] for a creatinine level >200 μmoles/liter). CONCLUSION Relapse of disease is common for patients with AAV. A creatinine level >200 μmoles/liter at the time of diagnosis is strongly associated with a reduced risk of relapse and may help guide monitoring and treatment of patients with AAV.
Collapse
Affiliation(s)
- Michael Walsh
- Division of Nephrology, St. Joseph's Hospital, Hamilton, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Mahr A, Katsahian S, Varet H, Guillevin L, Hagen EC, Höglund P, Merkel PA, Pagnoux C, Rasmussen N, Westman K, Jayne DRW. Revisiting the classification of clinical phenotypes of anti-neutrophil cytoplasmic antibody-associated vasculitis: a cluster analysis. Ann Rheum Dis 2012; 72:1003-10. [PMID: 22962314 DOI: 10.1136/annrheumdis-2012-201750] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Granulomatosis with polyangiitis (Wegener's) (GPA) and microscopic polyangiitis (MPA) are subgroups of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) defined historically by clinical and histological features. GPA and MPA are heterogeneous entities with overlapping phenotypes. To identify novel subgroupings, cluster analysis was used to explore the phenotypic spectrum of AAV. METHODS This study used a dataset of patients newly diagnosed as having GPA and MPA enrolled in five clinical trials. One cluster model included nine clinical baseline variables as input variables, and a second cluster model additionally included ANCA specificities. The clustering process involved multiple correspondence analyses followed by hierarchical ascendant cluster analysis. The clinical relevance of the generated clusters was analysed by their summary characteristics and outcomes. RESULTS The analyses involved data for 673 subjects: 396 (59%) with GPA and 277 (41%) with MPA. Both cluster models resulted in five partially redundant clusters of subjects, and the model including ANCA resulted in more pertinent separations. These clusters were named 'renal AAV with proteinase 3 (PR3)-ANCA' (40% of subjects), 'renal AAV without PR3-ANCA' (32%) and 'non-renal AAV' (12%), 'cardiovascular AAV' (9%) and 'gastrointestinal AAV' (7%). The five clusters had distinct death and relapse rates. On the basis of 4 variables, 651 subjects (97%) could be accurately allocated to 1 of the 5 classes. CONCLUSIONS This analysis suggests that AAV encompasses five classes associated with different outcomes. As compared with the traditional GPA-MPA separation, this classification system may better reflect the phenotypic spectrum of AAV.
Collapse
Affiliation(s)
- Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris 7, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Miyazaki N, Matsumoto J, Alberici F, Palmisano A, Maritati F, Oliva E, Buzio C, Vaglio A, Mjoen G, Norby GE, Vikse BE, Svarstad E, Rune B, Knut A, Szymczak M, Kuzniar J, Kopec W, Marchewka Z, Klinger M, Arrizabalaga P, Silvarino R, Sant F, Espinosa G, Sole M, Cervera R, Gude D, Chennamsetty S, Demin A, Kozlov V, Lisukov I, Kotova O, Sizikov A, Sergeevicheva V, Demina L, Borjesson O, Wendt M, Avik A, Qureshi AR, Bratt J, Miller EJ, Gunnarsson I, Bruchfeld A, Sugiyama K, Hasegawa M, Yamamoto K, Hayashi H, Koide S, Murakami K, Tomita M, Yoshida S, Yuzawa Y, Yew S, Jayne D, Westman K, Hoglund P, Flossman O, Mahr A, Luqmani R, Robson J, Thervet E, Levi C, Guiard E, Roland M, Nochy D, Daniliuc C, Guillevin L, Mouthon L, Jacquot C, Karras A, Kimura Y, Morita H, Debiec H, Yamada H, Miura N, Banno S, Ronco P, Imai H, Shin DH, Famee D, Koo HM, Han SH, Choi KH, Yoo TH, Kang SW, Fofi C, Fofi C, Scabbia L, Festuccia F, Stoppacciaro A, Mene' P, Shimizu A, Fukui M, MII A, Kaneko T, Masuda Y, Iino Y, Katayama Y, Fukuda Y, Kuroki A, Matsumoto K, Akizawa T, Jurubita R, Ismail G, Bobeica R, Rusu E, Zilisteanu D, Andronesi A, Motoi O, Ditoiu V, Copaci I, Voiculescu M, Irazabal MV, Eirin A, Lieske JC, Beck LH, Dillon JJ, Nachman PH, Sethi S, Erickson SB, Cattran DC, Fervenza FC, Svobodova B, Hruskova Z, Janatkova I, Jancova E, Tesar V, Seo MS, Kwon SH, Lee EB, You JY, Hyun YK, Woo SA, Park MY, Choi SJ, Jeon JS, Noh H, Kim JG, Han DC, Hwang SD, Choi TY, Jin SY, Kwon SH, Loiacono E, Loiacono E, Defedele D, Puccinelli MP, Camilla R, Gallo R, Peruzzi L, Rollino C, Beltrame G, Ferro M, Vergano L, Campolo F, Amore A, Coppo R, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Teranishi J, Yamamoto R, Nagasawa Y, Shoji T, Iwatani H, Okada N, Moriyama T, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y, Koo HM, Doh FM, Kim SJ, Kang SW, Choi KH, Han DS, Han SH, Suzuki Y, Matsuzaki K, Suzuki H, Okazaki K, Yanagawa H, Maiguma M, Muto M, Sato T, Horikoshi S, Novak J, Hotta O, Tomino Y, Gutierrez* E, Zamora I, Ballarin J, Arce Y, Jimenez S, Quereda C, Olea T, Martinez-Ara J, Segarra A, Bernis C, Garcia A, Goicoechea M, Garcia de Vinuesa S, Rojas J, Praga M, Ristovska V, Petrushevska G, Grcevska L, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Satake K, Shimizu Y, Mugitani N, Suzuki H, Suzuki Y, Horikoshi S, Honda S, Shibuya K, Shibuya A, Tomino Y, Papale M, Rocchetti MT, DI Paolo S, Suriano IV, D'apollo A, Vocino G, Montemurno E, Varraso L, Grandaliano G, Gesualdo L, Huerta A, Bomback AS, Canetta PA, Radhakrishnan J, Herlitz L, Stokes B, D'agati V, Markowitz G, Appel GB, Ristovska V, Grcevska L, Mouna H, Nasr BD, Mrabet I, Ahmed L, Sabra A, Mohamed Ammeur F, Mezri E, Habib S, Innocenti M, Pasquariello A, Pasquariello G, Mattei P, Bottai A, Fumagalli G, Bozzoli L, Samoni S, Cupisti A, Caldin B, Hung J, Repizo L, Malheiros DM, Barros R, Woronik V, Giammarresi C, Bono L, Ferrantelli A, Tortorici C, Licavoli G, Rotolo U, Huang X, Wang Q, Shi M, Chen W, Liu Z, Scarpioni R, Cantarini L, Lazzaro A, Ricardi M, Albertazzi V, Melfa L, Concesi C, Vallisa D, Cavanna L, Gungor G, Ataseven H, Demir A, Solak Y, Biyik M, Ozturk B, Polat I, Kiyici A, Ozer Cakir O, Polat H, Martinez-Ara J, Castillo I, Carreno V, Aguilar A, Madero R, Hernandez E, Bernis C, Bartolome J, Gea F, Selgas R, El Aggan HAM, El Banawy HS, Wagdy E, Tchebotareva N, LI O, Bobkova I, Kozlovskaya L, Varshavskiy V, Golicina E, Chen Y, Gong Z, Chen X, Tang L, Zhou J, Cao X, Wei R, Koo EH, Koo EH, Park JH, Kim HK, Kim MS, Jang HR, Lee JE, Huh W, Kim DJ, Oh HY, Kim YG, Tchebotareva N, Bobkova I, Kozlovskaya L, LI O, Eskova O, Shvetsov M, Golytsina E, Varshavskiy V, Popova O, Quaglia M, Monti S, Fenoglio R, Menegotto A, Airoldi A, Izzo C, Rizzo MA, Dianzani U, Stratta P, Vaglio A, Vaglio A, Alberici F, Gianfreda D, Buzio C. Primary and secondary glomerulonephritis I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Valdivia Vega RP, Perez Carlos J, LI X, LI X, Xu X, Zhang W, Ren H, Chen N, Yorioka N, Doi T, Hirashio S, Arita M, Hirabayashi A, Tilkiyan E, Chonova E, Ronchev Y, Kumchev E, Giamalis P, Spartalis M, Stangou M, Tsouchnikas I, Moysiades D, Dimopoulou D, Garyfalos A, Efstratiadis G, Memmos D, Schonermarck U, Eichhorn P, Sitter T, Wendler T, Vielhauer V, Lederer S, Fechner K, Fischereder M, Bantis C, Heering P, Kouri NM, Stangou M, Schwandt C, Kuhr N, Ivens K, Rump LC, Matta V, Melis P, Conti M, Cao R, Binda V, Altieri P, Asunis AM, Catani W, Floris M, Angioi A, Congia M, Cucca F, Minerba L, Peri M, Pani A, Beck LH, Fervenza FC, Fervenza FC, Bomback AS, Ayalon R, Irazabal MV, Eirin A, Cattran DC, Appel GB, Salant DJ, Santoro D, Postorino A, Costantino G, Bellinghieri G, Savica V, Weiner M, Goh SM, Mohammad A, Eriksson P, Westman K, Selga D, Salama A, Segelmark M, Chocova Z, Hruskova Z, Mareckova H, Svobodova B, Jancova E, Bednarova V, Rysava R, Tesar V, Hruskova Z, Jancova E, Hanzal V, Zamboch K, Grussmannova M, Svojanovsky J, Klaboch J, Kubisova M, Sevcik J, Olsanska R, Sobotkova M, Becvar R, Nemec P, Kodeda M, Jilek D, Chocova Z, Tesar V, Hussain M, Dhaygude A, Cartery C, Cartery C, Huart A, Plaisier E, Bongard V, Montastruc F, Ronco P, Pourrat J, Chauveau D, Prasad N, Gurjar D, Bhadauria D, Sharma RK, Gupta A, Kaul A, Jain M, Venning M, Brown N, Bruce I, Noor S, Dhaygude A, Bekker P, Potarca A, Dairaghi D, Miao S, Powers JP, Jaen JC, Schall TJ, Kalavrizioti D, Kalavrizioti D, Gerolymos M, Komninakis D, Rodi M, Mouzaki A, Kalliakmani P, Goumenos D, Choi BS, Choi BS, Park CW, Kim YS, Yang CW, Sun IO, Qin W, Xie L, Tan C, Qin W, Mian W, Fu P, Tan C, Kaminskyy V, Bantis C, Heering P, Kouri NM, Kuhr N, Schwandt C, Ivens K, Rump LC, Hao X, Hao X, Ren H, Wang W, Chen N, Cengiz C, Nur C, Nurdan Y, Selman G, Pinar T, Mehmet T, Lale S, Caliskan S, Shinzawa M, Yamamoto R, Nagasawa Y, Oseto S, Mori D, Niihata K, Fukunaga M, Yamauchi A, Tsubakihara Y, Rakugi H, Isaka Y, Chen JS, Lin YF, Lin WY, Shu KH, Chen HH, Wu CJ, Yang CS, Tseng TL, Zaza G, Bernich P, Lupo A, Panizo N, Rivera F, Lopez Gomez JM, Regn SROG, Ceresini G, Vaglio A, Urban ML, Corradi D, Usberti E, Palmisano A, Buzio C, Vaglio A, Zineb H, Ramdani B, Marques LPJ, Rioja LDS, Rocco R, Nery ACF, Novaes BC, Bridoux F, Sicard A, Labatut D, Touchard G, Sarkozy C, Vanhille P, Callard P, Essig M, Provot F, Nony A, Ronco P, Karras A, Agustin CP, M Belen HR, Carmen CP, Eliana O, Elisa P, Luis P, Alberto MC, Javier N, Isabel F, Cao R, Conti M, Atzeni A, Fois A, Piras D, Maxia S, Angioi A, Binda V, Melis P, Sau G, Pili G, Floris M, Asunis AM, Porcu M, Derudas D, Angelucci E, Ledda A, La Nasa G, Pani A, Ossareh S, Asgari M, Savaj S, Ataipour Y, Abdi E, Malakoutian T, Rajaa R, Berkchi FZ, Haffane L, Squalli Z, Rouass L, Al Hamany Z, Ezzaitouni F, Benamar L, Bayahya R, Ouzeddoun N, Gao-Yuan H, Yao X, Xin C, Zhen C, Yong-Chun G, Qing-Wen W, Hui-Ping C, Da-XI J, De-Hua G, Wei-Xin H, Zhi-Hong L, Rajaa R, Fatima Zahra B, Laila H, Zoubair S, Rouass L, Al Hamany Z, Ezzaitouni F, Benamar L, Bayahya R, Naima O, Smykal-Jankowiak K, Niemir Z, Polcyn-Adamczak M, Szramka-Pawlak B, Zaba R, Zhang C, Zhang C, Ren H, MA Y, Wang W, Zhang W, Shen P, Chen N, Ouyang Y, Ouyang Y, Pan X, Wang Z, Feng X, Shen P, Ren H, Ni L, Zhang W, Chen N. Primary and secondary glomerulonephritis II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Sartz L, Olin AI, Kristoffersson AC, Ståhl AL, Johansson ME, Westman K, Fremeaux-Bacchi V, Nilsson-Ekdahl K, Karpman D. A novel C3 mutation causing increased formation of the C3 convertase in familial atypical hemolytic uremic syndrome. J Immunol 2012; 188:2030-7. [PMID: 22250080 DOI: 10.4049/jimmunol.1100319] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atypical hemolytic uremic syndrome has been associated with dysregulation of the alternative complement pathway. In this study, a novel heterozygous C3 mutation was identified in a factor B-binding region in exon 41, V1636A (4973 T > C). The mutation was found in three family members affected with late-onset atypical hemolytic uremic syndrome and symptoms of glomerulonephritis. All three patients exhibited increased complement activation detected by decreased C3 levels and glomerular C3 deposits. Platelets from two of the patients had C3 and C9 deposits on the cell surface. Patient sera exhibited more C3 cleavage and higher levels of C3a. The C3 mutation resulted in increased C3 binding to factor B and increased net formation of the C3 convertase, even after decay induced by decay-accelerating factor and factor H, as assayed by surface plasmon resonance. Patient sera incubated with washed human platelets induced more C3 and C9 deposition on the cell surface in comparison with normal sera. More C3a was released into serum over time when washed platelets were exposed to patient sera. Results regarding C3 and C9 deposition on washed platelets were confirmed using purified patient C3 in C3-depleted serum. The results indicated enhanced convertase formation leading to increased complement activation on cell surfaces. Previously described C3 mutations showed loss of function with regard to C3 binding to complement regulators. To our knowledge, this study presents the first known C3 mutation inducing increased formation of the C3 convertase, thus explaining enhanced activation of the alternative pathway of complement.
Collapse
Affiliation(s)
- Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund 22184, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Harper L, Morgan MD, Walsh M, Hoglund P, Westman K, Flossmann O, Tesar V, Vanhille P, de Groot K, Luqmani R, Flores-Suarez LF, Watts R, Pusey C, Bruchfeld A, Rasmussen N, Blockmans D, Savage CO, Jayne D. Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis 2011; 71:955-60. [PMID: 22128076 DOI: 10.1136/annrheumdis-2011-200477] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The previously reported randomised controlled trial of a consensus regimen of pulse cyclophosphamide suggested that it was as effective as a daily oral (DO) cyclophosphamide for remission induction of antineutrophil cytoplasm autoantibodies-associated systemic vasculitis when both were combined with the same glucocorticoid protocol (CYCLOPS study (Randomised trial of daily oral versus pulse Cyclophosphamide as therapy for ANCA-associated Systemic Vasculitis published de groot K, harper L et al Ann Int Med 2009)). The study had limited power to detect a difference in relapse. This study describes the long-term outcomes of patients in the CYCLOPS study. METHODS Long-term outcomes were ascertained retrospectively from 148 patients previously recruited to the CYCLOPS Trial. Data on survival, relapse, immunosuppressive treatment, cancer incidence, bone fractures, thromboembolic disease and cardiovascular morbidity were collected from physician records retrospectively. All patients were analysed according to the group to which they were randomised. RESULTS Median duration of follow-up was 4.3 years (IQR, 2.95-5.44 years). There was no difference in survival between the two limbs (p=0.92). Fifteen (20.8%) DO and 30 (39.5%) pulse patients had at least one relapse. The risk of relapse was significantly lower in the DO limb than the pulse limb (HR=0.50, 95% CI 0.26 to 0.93; p=0.029). Despite the increased risk of relapse in pulse-treated patients, there was no difference in renal function at study end (p=0.82). There were no differences in adverse events between the treatment limbs. DISCUSSION Pulse cyclophosphamide is associated with a higher relapse risk than DO cyclophosphamide. However, this is not associated with increased mortality or long-term morbidity. Although the study was retrospective, data was returned in 90% of patients from the original trial.
Collapse
Affiliation(s)
- Lorraine Harper
- School of Immunity and Infection, University of Birmingham, Birmingham, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Suppiah R, Judge A, Batra R, Flossmann O, Harper L, Höglund P, Javaid MK, Jayne D, Mukhtyar C, Westman K, Davis JC, Hoffman GS, McCune WJ, Merkel PA, St Clair EW, Seo P, Spiera R, Stone JH, Luqmani R. A model to predict cardiovascular events in patients with newly diagnosed Wegener's granulomatosis and microscopic polyangiitis. Arthritis Care Res (Hoboken) 2011; 63:588-96. [PMID: 21452269 DOI: 10.1002/acr.20433] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To create a prognostic tool to quantify the 5-year cardiovascular (CV) risk in patients with newly diagnosed Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA) without premorbid CV disease. METHODS We reviewed CV outcomes during the long-term followup of patients in the first 4 European Vasculitis Study Group (EUVAS) trials of WG and MPA. CV events were defined as CV death, stroke, myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention. Logistic regression was performed to create a model to predict the absolute risk of a CV event. The model was tested using the Wegener's Granulomatosis Etanercept Trial (WGET) cohort. RESULTS Seventy-four (13.8%) of 535 patients with 5 years of followup from the EUVAS trials had at least 1 CV event: 33 (11.7%) of 281 WG versus 41 (16.1%) of 254 MPA. The independent determinants of CV outcomes were older age (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.11-1.90), diastolic hypertension (OR 1.97, 95% CI 0.98-3.95), and positive proteinase 3 (PR3) antineutrophil cytoplasmic antibody (ANCA) status (OR 0.39, 95% CI 0.20-0.74). The model was validated using the WGET cohort (area under the receiver operating characteristic curve of 0.80). CONCLUSION Within 5 years of diagnosis of WG or MPA, 14% of patients will have a CV event. We have constructed and validated a tool to quantify the risk of a CV event based on age, diastolic hypertension, and PR3 ANCA status in patients without prior CV disease. In patients with vasculitis, PR3 ANCA is associated with a reduced CV risk compared to myeloperoxidase ANCA or negative ANCA status.
Collapse
|