A new study has found that treatment regimens containing cyclophosphamide (CYC), CYC and rituximab (RTX), and RTX are similarly effective in inducing remission in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, a complication of ANCA-associated vasculitis (AAV).
“Closely examining current AAV induction therapies in the elderly population is paramount to improving overall outcomes,” the authors wrote. “We aimed to retrospectively investigate the efficacy and safety of three induction regimens: Glucocorticoids used in combination with either cyclophosphamide or rituximab or both in patients with AAV vasculitis who were 60 years and older in a single university medical center.”
The research team assessed the electronic medical records of 75 patients at least 60 years old who were diagnosed with AAV from the Johns Hopkins Vasculitis Center database between 2004 and 2020. The patients were divided into 3 remission induction groups: CYC, CYC + RTX, and RTX. Demographics, disease characteristics, symptoms, immunosuppression details, and outcomes including remission, vasculitis, death, end-stage renal disease, relapses, and leukopenia were collected.
The results revealed that CYC, CYC + RTX, and RTX were equally effective at inducing remission in patients over age 60 with ANCA-associated glomerulonephritis. Compared with CYC alone, RTX alone was found to be associated with a reduced risk of bone marrow suppression.
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No deaths were reported at 1 year after treatment initiation. There was a moderate risk of infections requiring hospitalization, most likely due to the use of high-dose glucocorticoids during the initial months of treatment. The authors highlighted the need for close monitoring of infections and using the lowest dose possible of glucocorticoids.
The research team concluded that the study results support the use of the 3 immunosuppression regimens in elderly individuals with AAV, and they provide clinicians with guidance on selecting the most appropriate induction therapy for each patient.
Aqeel F, Xu L, Salas A, et al. Outcomes of remission induction therapy for ANCA-associated vasculitis in the elderly. Clin Rheumatol. Published online May 25, 2023. doi.10.1007/s10067-023-06644-2