OP0029 MAINTENANCE TREATMENT FOR ANCA-ASSOCIATED VASCULITIS IN REAL WORLD PRACTICE IN EUROPE – REALITY OF VASCULITIS REMISSION AND RELAPSE AND SIGNIFICANT BURDEN OF DISEASE
Authors: P. Rutherford, D. Götte
Journal: Annals of the Rheumatic Diseases (2020)

Background: After successful remission induction, ANCA associated vasculitis (AAV) is a relapsing remitting long term condition and patients are at risk of organ damage from both active AAV and therapy in particular glucocorticoids (GC). The remission maintenance phase of AAV is critical for preventing relapse and ensuring organ protection. Objectives: This retrospective study aimed to examine the definition of maintenance start, therapy used and clinical outcomes in patients managed in routine clinical practice. Methods: 1478 AAV patients (France, Germany, Italy, Spain and UK) managed by 493 physicians (37% Rheumatologists) who completed induction therapy for organ or life threatening AAV and initiated maintenance therapy between 2014-16 were studied. Data were collected at the time maintenance was determined to begin by the physician and then at 6, 12, 18 and 36 months. Results: 49% had granulomatosis with polyangiitis,; mean age 54.2 years with 56% male. 49% had incident AAV and 51% were studied from a relapse. 70% received cyclophosphamide and GC and 30% received rituximab and GC. Physicians defined time of the start of maintenance from induction treatment start with mean of 5.7 months on basis of fixed time point 40%, starting new drug for maintenance 26%, reaching full remission 26% and no specific criteria 8%. At this time 43% were in full remission vs 50% in partial and 7% refractory. Various maintenance regimes were used, 21% received rituximab (88% 6 monthly and 8% 12 monthly, 4% other) at varying planned doses 34% 1g, 40% 500 mg and 23% 375 mg/m2, 4% other regime. Remission rates varied, relapse of different severity still occurs and many patients experienced adverse events (AE) and infections with prolonged GC use being common. Maintenance start 6 months 12 months 18 months 36 months Remission full/partial % 43 / 50 59 / 38 67 / 30 72 / 25 74 / 22 Total relapse / major % 12/49 9 / 45 6/ 44 7 / 32 Receiving GC% 65 61 53 46 39 At least one AE % 66 52 48 43 42 At least one infection % 54 42 32 27 26 At the most recent clinic review patients had been followed for a mean of 50.7 months – 6% had died, 38% had relapsed at least once, and 11% required renal replacement therapy. 54% had no vasculitis activity, 26% were ANCA positive without active disease and 19% still experiencing active disease. 32% were still receiving GCs - 22% of them receiving &gt; 5mg/ day. There was negative impact on functional status with 14% reducing working hours, 13% restricted social life, 6% leaving employment, 6% registered as disabled and 2% leaving full time education. Conclusion: The start of maintenance treatment in AAV is variably defined but typically at 6 months after start of remission induction therapy. Achieving full remission and preventing relapse are still clinical problems and many patients require ongoing GC therapy to maintain remission. Infectious complications and adverse events are common and there is significant negative impact on patient functional status over time. Disclosure of Interests: Peter Rutherford Shareholder of: Vifor Pharma, Employee of: Vifor Pharma, Baxter Healthcare, Dieter Götte Shareholder of: Vifor Pharma, Employee of: Vifor Pharma