Vasculitis & polymyalgia rheumatica
Induction failure in granulomatosis with polyangiitis: a nationwide case-control study of risk factors and outcomes
Authors' conclusion
In patients with induction failure, characteristics of GPA, salvage therapies and their efficacy vary according to induction therapy and failure modality.
Study context
- Population
- Patients with granulomatosis with polyangiitis (GPA) with induction failure, nationwide, 2006–2021; median age at induction 49 years51 cases (29 men, 22 women)
- Comparison
- GPA with induction failure vs matched controls
- Induction failuren = 51
- Outcome
- Characteristics associated with induction failure
Methodological detailsnationwide, each case randomly paired to three controls matched for age, sex and induction treatment
- Nationwide
- Each case randomly paired to three controls matched for age, sex and induction treatment
Main finding
As reported in the abstract
- ivCYC induction failure vs controls: PR3-ANCA
- 93% vs 70%, P = 0.02
- ivCYC induction failure vs controls: relapsing disease
- 41% vs 7%, P < 0.001
- ivCYC induction failure vs controls: orbital mass
- 15% vs 0%, P < 0.01
- Progression despite rituximab (RTX) induction vs controls: renal involvement
- 67% vs 25%, P = 0.02
- Progression despite RTX induction vs controls: renal failure (serum creatinine >100 µmol/l)
- 42% vs 8%, P = 0.02
Observational data: associations, not effects.
Further findings
Remission at 6 months after salvage therapy (all induction failures)
- Remission after salvage therapy
- 35 (69%)
Efficacy of switching from ivCYC to RTX (or vice versa), the most frequent salvage therapy
- Efficacy of switch
- 21/29 (72%)
Remission after salvage therapy, inappropriate response to ivCYC
- Remission
- 9 (50%)
Remission after salvage therapy, progression after RTX induction
- Remission with ivCYC (with or without immunomodulatory therapy)
- 4 (100%)
- Remission after adding immunomodulatory therapy alone
- 3 (50%)
Original publication
Induction failure in granulomatosis with polyangiitis: a nationwide case-control study of risk factors and outcomes. Rheumatology (Oxford). Published 27 February 2023. doi:10.
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