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Predictors of early relapse in patients with non-infectious mixed cryoglobulinemia vasculitis: results from the French nationwide CryoVas survey.

Abstract：

OBJECTIVE:Although in most patients induction therapy leads to complete or partial remission, relapses in patients with non-infectious mixed cryoglobulinemia vasculitis (CryoVas) remain a major problem. We aimed to identify predictors of early relapses occurring within the first 12months of treatment in such patients. METHODS:Patients included in the French CryoVas survey exhibiting complete/partial clinical remission and followed-up for at least 12months after induction therapy (n=145) were analyzed for predictors of early relapses. RESULTS:Forty out of 145 patients (28%) experienced early relapse. Relapses occurred after a median time of 9.5months after induction therapy (3-12) and involved skin (75%), joints and peripheral nerve (28% each), kidneys (25%) and gastrointestinal tract (5%). Baseline factors associated with an early relapse were purpura [HR 3.35 (1.02-10.97), P=0.046], cutaneous necrosis [HR 4.46 (1.58-12.57), P=0.005] and articular involvement [HR 2.20 (1.00-4.78), P=0.048]. The only factor negatively associated with an early relapse during follow-up was the achievement of complete immunological response [HR 0.07 (0.01-0.51), P=0.009]. The use of corticosteroids plus rituximab or cyclophosphamide tended to be associated negatively with early relapse [HR 0.43 (0.17-1.08), P=0.07]. CONCLUSION:In patients with non-infectious CryoVas, main predictors of early relapses after initial remission are purpura, articular involvement, and cutaneous necrosis. The absence of complete immunological response during follow-up was associated with early relapse. These findings may help in adapting future treatment strategies.

journal_name

Autoimmun Rev

journal_title

Autoimmunity reviews

authors

Terrier B,Marie I,Launay D,Lacraz A,Belenotti P,de Saint-Martin L,Quemeneur T,Huart A,Bonnet F,Le Guenno G,Kahn JE,Hinschberger O,Rullier P,Diot E,Lazaro E,Bridoux F,Zénone T,Carrat F,Hermine O,Léger JM,Mariette X

doi

10.1016/j.autrev.2013.11.006

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

630-4

issue

eissn

1568-9972

issn

1873-0183

pii

S1568-9972(14)00007-X

journal_volume

pub_type

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Predictors of early relapse in patients with non-infectious mixed cryoglobulinemia vasculitis: results from the French nationwide CryoVas survey.