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Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis.

Abstract：

OBJECTIVES:A prospective randomised trial to compare two different durations of maintenance immunosuppressive therapy for the prevention of relapse in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). METHODS:Patients with AAV were recruited 18-24 months after diagnosis if they were in stable remission after cyclophosphamide/prednisolone-based induction followed by azathioprine/prednisolone maintenance therapy. They were randomised (1:1) to receive continued azathioprine/prednisolone to 48 months from diagnosis (continuation group) or to withdraw azathioprine/prednisolone by 24 months (withdrawal group). The primary endpoint was the relapse risk, from randomisation to 48 months from diagnosis. RESULTS:One hundred and seventeen patients were randomised and 110 remained to the trial end. At entry, median serum creatinine was 116 μmol/L (range 58-372), 53% were ANCA positive. The percentage of patients presenting with relapse was higher in the withdrawal than in the continuation treatment group (63% vs 22%, p<0.0001, OR 5.96, 95% CI 2.58 to 13.77). ANCA positivity at randomisation was associated with relapse risk (51% vs 29%, p=0.017, OR 2.57, 95% CI 1.16 to 5.68). Renal function, ANCA specificity, vasculitis type and age were not predictive of relapse. Severe adverse events were more frequent in the continuation than withdrawal groups (nine vs three events), but the continuation group had better renal outcome (0 vs 4 cases of end-stage renal disease), with no difference in patient survival. CONCLUSIONS:Prolonged remission maintenance therapy with azathioprine/prednisolone, beyond 24 months after diagnosis reduces relapse risk out to 48 months and improves renal survival in AAV. TRIAL REGISTRATION NUMBER:ISRCTN13739474.

journal_name

Ann Rheum Dis

journal_title

Annals of the rheumatic diseases

authors

Karras A,Pagnoux C,Haubitz M,Groot K,Puechal X,Tervaert JWC,Segelmark M,Guillevin L,Jayne D,European Vasculitis Society.

doi

10.1136/annrheumdis-2017-211123

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1662-1668

issue

eissn

0003-4967

issn

1468-2060

pii

annrheumdis-2017-211123

journal_volume

pub_type

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Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis.