Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis

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Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis

Weiner, Maria, 1987- (författare): Linköpings universitet,Linköping University,Medicinska fakulteten,Avdelningen för diagnostik och specialistmedicin,Region Östergötland, Njurmedicinska kliniken US

Goh, Su Mein (författare): University College London Centre for Nephrology, Royal Free Hospital, London, UK; Department of Renal Medicine, Tan Tock Seng Hospital, Singapore

Mohammad, Aladdin (författare): Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund OsteoArthritis Division - Clinical Epidemiology Unit,Forskargrupper vid Lunds universitet,Autoimmunitet och njursjukdomar,Lund Vasculitis Epidemiology Research Group,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups,Autoimmunity and kidney diseases,Department of Clinical Sciences, Section of Rheumatology, Lund University; Department of Medicine, University of Cambridge, UK

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Hruškova, Zdenka (författare): Department of Nephrology, First Faculty of Medicine, Charles University, Prague, Czech Republic; General University Hospital, Prague, Czech Republic

Tanna, Anisha (författare): Department of Medicine, Imperial College London, UK

Sharp, Phoebe (författare): Institute of Clinical Sciences, University of Birmingham, UK

Kang, Amy (författare): Department of Medicine, Imperial College London, UK

Bruchfeld, Annette (författare): Karolinska Institutet,Department of Renal Medicine, CLINTEC, Karolinska University Hospital

Selga, Daina (författare): Lund University,Lunds universitet,Njurmedicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Autoimmunitet och njursjukdomar,Forskargrupper vid Lunds universitet,Nephrology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Autoimmunity and kidney diseases,Lund University Research Groups,Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö

Chocova, Zdenka (författare): Department of Nephrology, First Faculty of Medicine, Charles University, Prague, Czech Republic; General University Hospital, Prague, Czech Republic

Westman, Kerstin (författare): Lund University,Lunds universitet,Njurmedicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Autoimmunitet och njursjukdomar,Forskargrupper vid Lunds universitet,Nephrology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Autoimmunity and kidney diseases,Lund University Research Groups,Department of Nephrology, Lund University, Skåne University Hospital, Lund and Malmö

Eriksson, Per, 1958- (författare): Linköpings universitet,Linköping University,Avdelningen för inflammation och infektion,Medicinska fakulteten,Region Östergötland, Reumatologiska kliniken i Östergötland

Harper, Lorraine (författare): Institute of Clinical Sciences, University of Birmingham, UK

Pusey, Charles D. (författare): Department of Medicine, Imperial College London, UK

Tesar, Vladimir (författare): Department of Nephrology, First Faculty of Medicine, Charles University, Prague, Czech Republic; General University Hospital, Prague, Czech Republic

Salama, Alan D. (författare): University College London Centre for Nephrology, Royal Free Hospital, London, UK

Segelmark, Mårten (författare): Linköpings universitet,Linköping University,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Njurmedicinska kliniken US

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2019-07-15
2020
Engelska.
Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 47:4, s. 580-588

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Objective. Age is a risk factor for organ damage, adverse events, and mortality in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, the relationship between treatment and damage, hospitalizations, and causes of death in elderly patients is largely unknown. Methods. Consecutive patients from Sweden, the United Kingdom, and the Czech Republic diagnosed between 1997 and 2013 were included. Inclusion criteria were a diagnosis of MPA or GPA and age 75 years or more at diagnosis. Treatment with cyclophosphamide (CYC), rituximab (RTX), and corticosteroids the first 3 months was registered. Outcomes up to 2 years from diagnosis included Vasculitis Damage Index (VDI), hospitalization, and cause of death. Results. Treatment data were available for 167 of 202 patients. At 2 years, 4% had no items of damage. There was a positive association between VDI score at 2 years and Birmingham Vasculitis Activity Score at onset, and a negative association with treatment using CYC or RTX. Intravenous methylprednisolone dose was associated with treatment-related damage. During the first year, 69% of patients were readmitted to hospital. Myeloperoxidase-antineutrophil cytoplasmic antibody positivity and lower creatinine levels decreased the odds of readmission. The most common cause of death was infection, and this was associated with cumulative oral prednisolone dose. Conclusion. Immunosuppressive treatment with CYC or RTX in elderly patients with MPA and GPA was associated with development of less permanent organ damage and was not associated with hospitalization. However, higher doses of corticosteroids during the first 3 months was associated with treatment-related damage and fatal infections.

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Av författaren/redakt...: Weiner, Maria, 1 ...; Goh, Su Mein; Mohammad, Aladdi ...; Hruškova, Zdenka; Tanna, Anisha; Sharp, Phoebe; visa fler...; Kang, Amy; Bruchfeld, Annet ...; Selga, Daina; Chocova, Zdenka; Westman, Kerstin; Eriksson, Per, 1 ...; Harper, Lorraine; Pusey, Charles D ...; Tesar, Vladimir; Salama, Alan D.; Segelmark, Mårte ...; visa färre...

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Av lärosätet: Lunds universitet; Karolinska Institutet; Linköpings universitet

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Effect of Treatment on Damage and Hospitalization in Elderly Patients with Microscopic Polyangiitis and Granulomatosis with Polyangiitis

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