Patients with history of autoimmune disease have fewer AAV relapses
Patients with ANCA-associated vasculitis who have a history of autoimmune disease prior to diagnosis may have fewer relapses following remission, according to data published in Clinical and Experimental Rheumatology.
“Clinical experience has shown that a proportion of [ANCA-associated vasculitis (AAV)] patients report a [past medical history (PMH)] of another autoimmune disorder at the time of AAV diagnosis,” Sophia Lionaki, MD, PhD, of the National and Kapodistrian University of Athens, and co-authors wrote. “We aimed to explore the frequency of a PMH of autoimmunity in these patients, and its impact, if any, in the clinical picture and treatment outcomes of vasculitis.”
To investigate the association between medical histories containing autoimmune disorders and vasculitis relapses, researchers analyzed patients with AAV diagnosed between 1991 and 2019 in a retrospective study. To be included, patients were required to be 16 years or older with biopsy proven disease. Additionally, precise medical history detailing autoimmune disorders needed to be available. Included patients also had at least 1 year of follow up. Patient observation lasted from AAV diagnosis until a diagnosis of end-stage kidney disease, the authors wrote.
Researchers focused on treatment resistance, remission, end-stage kidney disease, relapse and death as outcomes. For the purpose of the study, treatment resistance was defined as “a progressive decline in kidney function, with persistently active urine sediment, and/or new or persistent extrarenal vasculitic manifestations or death attributed to active vasculitis despite appropriate therapy.” Remission was defined as the stabilization or improvement of kidney function as measured by serum creatinine levels.
In total, 206 patients with AAV and sufficient history data were included in the analysis. Of those, 63 patients had a history of autoimmune disease before AAV diagnosis. According to the researchers, remission rates were similar among patients with and without a medical history of autoimmune disease. However, relapse-free periods were “significantly” longer in patients with a history of autoimmune disease. Patients with autoimmune diseases had a relapse-free survival period of 148.2 months, while those without had a mean period of 61.9 months (P < .001). An analysis that adjusted for covariates showed that patients with a history of autoimmune diseases had a lower risk for disease relapse (HR = 0.33; 95% CI, 0.15-0.72).
"Patients with a PMH of autoimmune disorders prior to AAV diagnosis were shown to have a different disease course following immunosuppressive therapy, compared to patients without such a history,” Lionaki and colleagues wrote. “The risk of relapse was significantly lower in the presence of a PMH of autoimmunity at the time of AAV diagnosis, a finding that remained significant after adjusting for sex, age and ANCA positivity.”
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