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Comparative Study
. 2008 Sep;58(9):2908-18.
doi: 10.1002/art.23800.

Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis: comparison of two independent cohorts

Christian Pagnoux  1 , Susan L Hogan, Hyunsook Chin, J Charles Jennette, Ronald J Falk, Loïc Guillevin, Patrick H Nachman
Affiliations
Comparative Study

Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis: comparison of two independent cohorts

Christian Pagnoux et al. Arthritis Rheum. 2008 Sep.

Abstract

Objective: Predictors of treatment resistance and relapse have been identified in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in the Glomerular Disease Collaborative Network (GDCN) in the southeastern US. This study was undertaken to evaluate the applicability of those predictors in an independent cohort followed up by the French Vasculitis Study Group.

Methods: Predictors of treatment resistance were evaluated using logistic regression models and reported as odds ratios (ORs) with 95% confidence intervals (95% CIs). Predictors of relapse were evaluated using Cox proportional hazards models and reported as hazard ratios (HRs) with 95% CIs. Models were controlled for age, sex, race, baseline serum creatinine level, and cyclophosphamide therapy.

Results: The French cohort (n = 434) and the GDCN cohort (n = 350) had similar median followup periods (44 months versus 45 months) and initial percentages of patients taking cyclophosphamide (82% versus 78%). The French cohort included more patients with proteinase 3 (PR3) ANCA (58% versus 40%), lung involvement (58% versus 49%), and upper respiratory tract involvement (62% versus 31%). Of the predictors of treatment resistance in the GDCN cohort (female sex, African American race, presence of myeloperoxidase ANCA, elevated creatinine level, and age), only age predicted treatment resistance in the French cohort (OR 1.32 per 10 years [95% CI 1.05-1.66]). Predictors of relapse in the GDCN cohort were PR3 ANCA (HR 1.77 [95% CI 1.11-2.82]), lung involvement (HR 1.68 [95% CI 1.10-2.57), and upper respiratory tract involvement (HR 1.58 [95% CI 1.00-2.48]), while predictors in the French cohort were PR3 ANCA (HR 1.66 [95% CI 1.15-2.39]) and lung involvement (HR 1.56 [95% CI 1.11-2.20]), but not upper respiratory tract involvement (HR 0.96 [95% CI 0.67-1.38]).

Conclusion: Our findings indicate that older age is a predictor of treatment resistance, and that PR3 ANCA and lung involvement are predictors of relapse in both cohorts. Discrepancies in predictors of treatment tract resistance may reflect differences in access to care, and differences in predictors of relapse may reflect variations in disease expression.

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Figures

Figure 1
Figure 1
Disposition of A, the French patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis followed up by the French Vasculitis Study Group and B, the US patients with ANCA vasculitis in the Glomerular Disease Collaborative Network.
Figure 2
Figure 2
Distribution of risk factors for relapse in A, the 359 patients in the French cohort and B, the 255 patients in the GDCN cohort in whom remission was achieved. PR3 ANCA = proteinase 3 antineutrophil cytoplasmic antibody.
See this image and copyright information in PMC

References

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    1. Falk RJ, Hogan S, Carey TS, Jennette JC, for the Glomerular Disease Collaborative Network Clinical course of anti-neutrophil cytoplasmic autoantibody-associated glomerulonephritis and systemic vasculitis. Ann Intern Med. 1990;113:656–63. - PubMed
    1. Hogan SL, Nachman PH, Wilkman AS, Jennette JC, Falk RJ. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. 1996;7:23–32. - PubMed
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