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Hogan SL, Nachman PH, Poulton CJ, et al. Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Kidney Int Rep. 2019;4(4):551-560doi: 10.1016/j.ekir.2019.01.004.
Hogan, S. L., Nachman, P. H., Poulton, C. J., Hu, Y., Blazek, L. N., Free, M. E., Jennette, J. C., & Falk, R. J. (2019). Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Kidney international reports, 4(4), 551-560. https://doi.org/10.1016/j.ekir.2019.01.004
Hogan, Susan L, et al. "Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis." Kidney international reports vol. 4,4 (2019): 551-560. doi: https://doi.org/10.1016/j.ekir.2019.01.004
Hogan SL, Nachman PH, Poulton CJ, Hu Y, Blazek LN, Free ME, Jennette JC, Falk RJ. Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Kidney Int Rep. 2019 Jan 28;4(4):551-560. doi: 10.1016/j.ekir.2019.01.004. eCollection 2019 Apr. PMID: 30993230; PMCID: PMC6451087.
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Kidney Int Rep. 2019 Jan 28;4(4):551-560. doi: 10.1016/j.ekir.2019.01.004. eCollection 2019 Apr.

Understanding Long-term Remission Off Therapy in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

Kidney international reports

Susan L Hogan, Patrick H Nachman, Caroline J Poulton, Yichun Hu, Lauren N Blazek, Meghan E Free, J Charles Jennette, Ronald J Falk

Affiliations

  1. Division of Nephrology, Department of Medicine, and the Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
  2. Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
  3. Division of Nephropathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

PMID: 30993230 PMCID: PMC6451087 DOI: 10.1016/j.ekir.2019.01.004

Abstract

INTRODUCTION: In antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis, relapse risk and long-term immunosuppressive therapy are problematic. Stopping immunotherapy has not been well described.

METHODS: The Glomerular Disease Collaborative Network ANCA vasculitis inception cohort was evaluated. Patients who stopped all immunotherapy and those continuously on immunotherapy (≥2 years) were included. Time to first period off therapy was modeled with end-stage kidney disease and death as competing risks to understand influences of stopping therapy. Cause-specific hazard ratios (HRs) with 95% confidence intervals (CI) and

RESULTS: In 427 patients, 277 (65%) stopped therapy (median 20 months from initial induction); 14% for ≥2 different periods of time and 23% for periods ≥5 years. In multivariable models of time to discontinuation of treatment, women (HR 1.33; 95% CI 1.04-1.70;

CONCLUSIONS: Stopping immunotherapy was common. Women and those treated with methylprednisolone stop treatment more often, but underlying mechanisms are unknown. Stopping treatment was associated with fewer relapses, suggesting that even without guidelines there may be benefits without an untoward detriment of relapse.

Keywords: ANCA; relapse; stopping therapy; time off therapy; vasculitis

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