Vasculitis & polymyalgia rheumatica
Incorporating frailty and disease severity into treatment decisions for older patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis
Authors' conclusion
Considering the enrichment for hospitalized patients with severe disease and advanced age, a mortality rate of 20% at 1 year that is comparable to less severe and younger cohorts suggests tailoring remission induction strategy according to a holistic assessment of frailty and disease activity may partially mitigate the higher risk of infection and mortality with advancing age.
Study context
- Population
- Hospitalized patients aged ≥75 years commencing remission induction with cyclophosphamide- or rituximab-based regimens for severe AAV, 2014–2021median age 79
- Participants
- 84 patients
- Exposure
- Remission induction regimens: rituximab-cyclophosphamide combination, cyclophosphamide, standard-dose rituximab, low-dose rituximab
- Outcome
- One-year mortality
- Follow-up
- 1 year
Methodological detailsMedian follow-up 21 months (IQR 12-44)
- Median follow-up 21 months (IQR 12-44)
Main finding
As reported in the abstract
One-year mortality, overall
20%
One-year mortality by treatment group, in the order rituximab-cyclophosphamide combination, cyclophosphamide, standard-dose rituximab, low-dose rituximab
10%, 23%, 14% and 26%
Increasing age and higher mortality, HR
4.15 (1.62, 10.6) (95% CI)
Observational data: associations, not effects.
Further findings
Mortality by increasing age
- Increasing age, HR
- 4.15 (95% CI 1.62, 10.6)
Serious infection by increasing age
- Increasing age, HR
- 1.18 (95% CI 0.47, 2.93)
Safety
Serious infection requiring hospital readmission · first year
- Serious infection requiring readmission, overall
- 27%
- Serious infection by treatment group, in the order rituximab-cyclophosphamide combination, cyclophosphamide, standard-dose rituximab, low-dose rituximab
- 37.5%, 23.8%, 25.8% and 31.6%
- Increasing age and serious infection (not associated), HR
- 1.18 (0.47, 2.93) (95% CI)
Original publication
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