MP121OUTCOME AND IMMUNOSUPPRESSIVE TREATMENT OF ELDERLY PATIENTS WITH ANCA-ASSOCIATED VASCULITIS

Abstract

Introduction and Aims: ANCA-associated vasculitis is commonly found in elderly patients, who are at great risk for infection. There are only few data concerning the outcome in elderly patients with immunosuppressive treatment in patients with ANCA-associated vasculitis. Combination therapy with steroid and cyclophosphamide has been used for remission induction of ANCA-associated vasculitis, but elderly patients receiving immunosuppression has an increased risk of infection. Some study showed the benefit of immunosuppressive treatment for elderly patients, but the best choice of immunosuppressive agent and optimum dose are unknown. The objective of this study is to find the efficacy immunosuppressive treatment for elderly patient. Methods: 44 consecutive patients with biopsy-proven ANCA-associated vasculitis between 2005 and 2015 in single center were analyzed retrospectively. Data on survival and renal function were analyzed by log-rank test. Results: The median age of all patients was 70 years (interquartile range, 64-78). 23 patients were defined as group 1 (age >= 70years) and 21 as group 2 (age < 70 years). Group 1 presented with higher clinical grade score than group 2, which is categorized by summing the four prognostic factor scores (serum creatinine, age, lung involvement and CRP). Total clinical grade score was 5.0 +/- 1.8, 3.5 +/- 2.7 in group 1 and group 2 (p=0.043), respectively. Baseline data (sex, BMI, Hb, Alb, Cr, CRP, ANCA, Birmingham Vasculitis Activity Score and organ involvement) and comorbidities (hypertension, hyperlipidemia, diabetes, CVD and smoke) at the time of diagnosis were not significantly different between two groups except age and clinical grade score. Median follow-up was 1654 days (interquartile rage, 833-2551). 1-year survival and 1-year renal survival were 92.7% and 72.5%, respectively. Mortality and renal survival were not significantly different between group 1 and group 2 (log-rank test : p=0.301, p=0.883, respectively). Total cyclophosphamide dose was 2288 +/- 2239 mg, 5895 +/- 6263 mg and daily mizoribine dose was 90 +/- 42 mg, 117 +/- 58 mg in group 1 and group 2 (p=0.145, p=0.347, respectively). Total methylprednisolone dose was 1857 +/- 857 mg, 2713 +/- 1584 mg in group 1 and group 2 (p=0.057). Daily prednisolone dose was 0.6 +/- 0.2 mg/kg, 0.8 +/- 0.2 mg/kg in group 1 and goup2 (p=0.031). Incidence of infection was not higher in patients treated with immunosuppressant (cyclophosphamide or mizoribine) than patients with steroid only in group 1 (log-rank test : p=0.165). Conclusions: The prognosis of ANCA-assosicated vasculitis of elderly patients was equivalent to that of young patients. There were no significant differences in the choice and the dose of immunosuppressive agents between elderly patients and young ones except steroid dose. The reduction of prednisolone dose for remission maintenance treatment may lower the risk of infection.