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

16 Apr 2020

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.

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Most Read Articles
5 days ago
The use of capsule endoscopy (CE) appears to be effective in the diagnosis of iron deficiency anaemia (IDA), yielding a 33.9-percent yield in this study, with 65.8 percent of patients undergoing further workup and 12.7 percent requiring therapeutic intervention.
Roshini Claire Anthony, 7 hours ago

For coffee drinkers, drinking filtered coffee may be tied to a lower mortality risk, including cardiovascular disease (CVD)-related mortality, a study from Norway suggested.

2 days ago
Eating behaviours have been shown to moderate the relationship between cumulated risk factors in the first 1,000 days and adiposity outcomes at 6 years of age, which underscores modifiable behavioural targets for interventions, reports a study.
Stephen Padilla, Yesterday
Use of noninvasive ventilation (NIV), similar to invasive mechanical ventilation (IMV), appears to lessen mortality but may increase the risk for transmission of the novel coronavirus disease (COVID-19) in healthcare workers, suggest the results of a study.