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Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and
Maria Weiner1,2, Su Mein Goh3,4, Aladdin J Mohammad3,4
1From the Department of Nephrology and Department of Medical and Health Sciences, Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund; Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institute, Stockholm; Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö; University College London Centre for Nephrology, Royal Free Hospital; Department of Medicine, Imperial College London, London; Institute of Clinical Sciences, University of Birmingham, Birmingham; Department of Medicine, University of Cambridge, Cambridge, UK; Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Renal Medicine, Tan Tock Seng Hospital, Singapore. maria.weiner@liu.se.
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.
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