[ANCA-vasculitis with renal impairment treated by intravenous versus oral cyclophosphamide: Multicentric analysis of relapse free survival (VaReCyS)].

Autor: Gouin JB; Service de néphrologie, centre hospitalier Bretagne Atlantique, 20, boulevard Général-Maurice, Guillaudot, 56017 Vannes, France. Electronic address: gouin.jeanbaptiste@gmail.com., Dhalluin T; Service de santé publique et épidémiologie, CHU Rennes Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France., Perrichot R; Service de néphrologie, centre hospitalier Bretagne Atlantique, 20, boulevard Général-Maurice, Guillaudot, 56017 Vannes, France., Vigneau C; Service de néphrologie, CHU Rennes Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Université de Rennes 1, IRSET U1085, 9, avenue du Professeur-Léon-Bernard, 35000 Rennes, France., Michel A; Service de néphrologie, centre hospitalier de Saint-Malo, 1, rue de la Marne, 35400 Saint-Malo, France.
Jazyk: francouzština
Zdroj: Nephrologie & therapeutique [Nephrol Ther] 2020 Jul; Vol. 16 (4), pp. 201-210. Date of Electronic Publication: 2020 Jul 09.
DOI: 10.1016/j.nephro.2020.03.009
Abstrakt: Introduction: ANCA-vasculitis are associated with high morbidity and mortality. Large use of cyclophosphamide as induction immunosuppressive therapy is limited by its side effects. All recent literature trends in decreasing cumulative dose while optimizing maintenance therapy.
Methods: This retrospective multicentric analysis included ANCA-vasculitis patients with renal impairment and de novo diagnose followed in Rennes and Vannes hospitals for 2 years minimum. The primary endpoint was to analyze relapse free survival comparing oral and intravenous administration of cyclophosphamide.
Results: From 01/01/2003 to 01/03/2016, 91 patients were included (45 oral and 46 intravenous group). Patients in oral group were 10 years younger (P<0,001), with higher maintenance therapy (P<0,001) and steroids (P<0,001) duration. With a Cox model adjusted on age, steroid and maintenance therapy duration, oral cyclophosphamide showed no benefice in decreasing relapse free survival (OR 0,80; 95%IC 0,38-1,66; P=0,55). No difference was observed on either mortality or renal survival. Oral group at 1-year trends to achieve more leucopenia (40 vs 24%) and infection (30 vs 22%) episodes, but less hospitalization (40 vs 65%), without reaching statistical significance.
Conclusion: In this retrospective multicentric analysis, oral cyclophosphamide induction was not associated with better relapse free survival after adjustment with age, steroid and maintenance therapy duration. Maintenance therapy duration is believed to better prevent ANCA-vasculitis relapse.
(Copyright © 2020 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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