Cyclophosphamide, rituximab tied to less permanent organ damage in older polyangiitis patients

Immunosuppressive treatment with cyclophosphamide and rituximab in elderly patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) is not associated with hospitalization and may result in the development of less permanent organ damage, reveals a study.

However, higher doses of corticosteroids during the first 3 months lead to treatment-related damage and fatal infections.

Of the 202 patients identified, 167 had available treatment data. Four percent of these patients had no items of damage at 2 years.

A positive association was seen between Vasculitis Damage Index (VDI) score at 2 years and Birmingham Vasculitis Activity Score at onset, while a negative association was found with cyclophosphamide or rituximab therapy. On the other hand, intravenous methylprednisolone dose correlated with treatment-related damage.

Sixty-nine percent of patients were readmitted to the hospital during the first year. The risk of readmission decreased with myeloperoxidase–antineutrophil cytoplasmic antibody positivity and lower creatinine levels. Infection was the most common cause of death and correlated with cumulative oral prednisolone dose.

The study identified consecutive patients from Sweden, UK and the Czech Republic diagnosed between 1997 and 2013 and included those with a diagnosis of MPA or GPA and aged ≥75 years at diagnosis. Treatment with cyclophosphamide, rituximab and corticosteroids for the first 3 months was recorded. Outcomes up to 2 years from diagnosis were VDI, hospitalization and cause of death.

“Age is a risk factor for organ damage, adverse events and mortality in MPA and GPA,” the authors said.