AB0591 Efficacy and safety profile of intravenous cyclophosphamide treatment in elderly patients with systemic vasculitis

Abstract

Background: Intravenous cyclophosphamide is mainstay of remission induction and dose reduction of glucocorticoid in patients with systemic vasculitis. However, little evidence has yet shown the safety profile of intravenous cyclophosphamide, especially in elderly patients. Objectives: To evaluate efficacy and safety of patients diagnosed as systemic vasculitis and treated with intravenous cyclophosphamide. Methods: This retrospective study comprised the patients with active systemic vasculitis who were admitted to Kitami Red Cross Hospital and Obihiro-Kosei General Hospital from April 2009 to March 2016. These patients were treated with intravenous cyclophosphamide plus conventional therapy (IVCY group) or only with conventional therapy (glucocorticoid/azathioprine/tacrolimus and methotrexate) (conventional therapy group). The patients treated with oral cyclophosphamide or rituximab were excluded. Primary endpoint was defined as death or serious infections. Prognostic factors in IVCY group were analyzed by multivariate Cox regression methods. Results: This study comprised 90 patients with active systemic vasculitis (61 microscopic polyangiitis, 9 eosinophilic granulomatosis with polyangiitis, 10 granulomatosis with polyangiitis, and 10 polyarteritis nodosa). Fifty-one patients were over 70-year-old (26 patients in IVCY group). The mean observation period was 30.1 months. IVCY group had a trend for higher event-free survival rate as compared with conventional therapy group (p=0.19). IVCY group had significantly higher cumulative survival rate as well (p=0.04). Age (HR=1.07, 95% CI 1.01- 1.14, p=0.03), five factor score (FFS, HR=3.39, 95% CI 1.36-8.44, p=0.01) and glucocorticoid dose at 24 weeks (GC24, HR=1.14, 95% CI 1.05-1.22, p=0.001) were identified as risk factors for events. In patients over 70-year-old, IVCY group had a trend for higher cumulative survival rate as well (p=0.07, Figure1). FFS (HR=3.30, 95% CI 1.19-9.15, p=0.02) and GC24 (HR=1.10, 95% CI 1.02-1.20, p=0.01) were identified as risk factors for events Conclusions: Intravenous cyclophosphamide treatment had acceptable safety profile even in elderly patients. (Figure presented) .