Clinical outcomes of treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on ANCA type

Sebastian Unizony, Miguel Villarreal, Eli M. Miloslavsky, Na Lu, Peter A. Merkel, Robert Spiera, Philip Seo, Carol A. Langford, Gary S. Hoffman, C. G.M. Kallenberg, E. William St. Clair, David Ikle, Nadia K. Tchao, Linna Ding, Paul Brunetta, Hyon K. Choi, Paul A. Monach, Fernando Fervenza, John H. Stone, Ulrich Specks

Research output: Contribution to journalArticle

88 Scopus citations

Abstract

Objective: To evaluate whether the classification of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) according to ANCA type (anti-proteinase 3 (PR3) or anti-myeloperoxidase (MPO) antibodies) predicts treatment response. Methods: Treatment responses were assessed among patients enrolled in the Rituximab in ANCA-associated Vasculitis trial according to both AAV diagnosis (granulomatosis with polyangiitis (GPA)/microscopic polyangiitis (MPA)) and ANCA type (PR3-AAV/MPO-AAV). Complete remission (CR) was defined as disease activity score of 0 and successful completion of the prednisone taper. Results: PR3-AAV patients treated with rituximab (RTX) achieved CR at 6 months more frequently than did those randomised to cyclophosphamide (CYC)/azathioprine (AZA) (65% vs 48%; p=0.04). The OR for CR at 6 months among PR3-AAV patients treated with RTX as opposed to CYC/AZA was 2.11 (95% CI 1.04 to 4.30) in analyses adjusted for age, sex and new-onset versus relapsing disease at baseline. PR3-AAV patients with relapsing disease achieved CR more often following RTX treatment at 6 months (OR 3.57; 95% CI 1.43 to 8.93), 12 months (OR 4.32; 95% CI 1.53 to 12.15) and 18 months (OR 3.06; 95% CI 1.05 to 8.97). No association between treatment and CR was observed in the MPO-AAV patient subset or in groups divided according to AAV diagnosis. Conclusions: Patients with PR3-AAV respond better to RTX than to CYC/AZA. An ANCA type-based classification may guide immunosuppression in AAV. Trial registration: number NCT00104299; post-results.

Original languageEnglish (US)
Pages (from-to)1166-1169
Number of pages4
JournalAnnals of the rheumatic diseases
Volume75
Issue number6
DOIs
StatePublished - Jun 2016

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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    Unizony, S., Villarreal, M., Miloslavsky, E. M., Lu, N., Merkel, P. A., Spiera, R., Seo, P., Langford, C. A., Hoffman, G. S., Kallenberg, C. G. M., St. Clair, E. W., Ikle, D., Tchao, N. K., Ding, L., Brunetta, P., Choi, H. K., Monach, P. A., Fervenza, F., Stone, J. H., & Specks, U. (2016). Clinical outcomes of treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on ANCA type. Annals of the rheumatic diseases, 75(6), 1166-1169. https://doi.org/10.1136/annrheumdis-2015-208073