The effect of achieving serological remission on subsequent risk of relapse, end-stage renal disease and mortality in ANCA-associated vasculitis: a target trial emulation study

Autor:	Gregory McDermott, Xiaoqing Fu, Claire Cook, Catherine Ahola, Brett Doliner, Jennifer Hanberg, John H Stone, Hyon K Choi, Yuqing Zhang, Zachary S Wallace
Rok vydání:	2022
Předmět:	Male Remission Induction Immunology Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis Middle Aged General Biochemistry Genetics and Molecular Biology Antibodies Antineutrophil Cytoplasmic Rheumatology Recurrence Humans Kidney Failure Chronic Immunology and Allergy Female Rituximab
Zdroj:	Annals of the Rheumatic Diseases. 81:1438-1445
ISSN:	1468-2060 0003-4967
Popis:	ObjectiveTo evaluate the effect of achieving a negative postinduction antineutrophil cytoplasmic antibody ANCA) assay on the risk of relapse, end-stage renal disease (ESRD) and death in ANCA-associated vasculitis (AAV).MethodsWe emulated a target trial using observational data from the Mass General Brigham AAV cohort comparing patients who achieved versus did not achieve serological remission (negative ANCA assay) within 180 days of induction. Outcomes were relapse, ESRD or death within 5 years, obtained from medical records, the US Renal Data System and the National Death Index. We placed a ‘clone’ of each patient in both trial arms, censored those deviating from their assigned protocol and weighted each by the inverse probability of censoring. Outcomes were assessed by pooled logistic regression.ResultsThe study included 506 patients with AAV. The mean age was 61 years (SD 18) and the majority were women (58%), white (87%), myeloperoxidase-ANCA+ (72%) and had renal involvement (68%). Rituximab (59%) or cyclophosphamide (33%) was most often used for induction treatment. Within 5 years, 81 (16%) died, 51 (10%) had ESRD and 64 (13%) had relapse. Patients treated to a negative ANCA assay within 180 days had HR 0.55 (95% CI 0.38 to 0.81) for relapse and HR 0.87 (95% CI 0.61 to 1.25) for the composite of ESRD or death within 5 years.ConclusionsIn this emulated target trial from a large AAV cohort, achieving serological remission within 180 days of induction was associated with lower risk of relapse, but no statistically significant difference in ESRD or mortality outcomes.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5b364c87f44a2976b3b887a748c89541 https://doi.org/10.1136/annrheumdis-2022-222439 Zobrazit plný text záznamu