Incorporating frailty and disease severity into treatment decisions for older patients with ANCA-associated vasculitis
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ID: 315024
2026
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Abstract
OBJECTIVE: Older patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are underrepresented in clinical trials, and long-term outcome data in this group are limited. We evaluated treatment approaches and outcomes among hospitalised older patients with AAV. METHODS: We retrospectively collected clinical and laboratory data on all hospitalised patients aged 75 years or older who commenced remission induction with cyclophosphamide- or rituximab-based regimens for severe AAV between 2014 and 2021. RESULTS: Eighty-four patients were included (median age 79, range 75-93), with a median follow-up of 21 months (IQR 12-44). Choice of induction regimen was influenced by age and frailty: the rituximab-cyclophosphamide combination was more commonly used in younger patients within the cohort, while low-dose rituximab was favoured for the oldest and most frail, including those requiring residential or nursing home care. The distribution of regimens was as follows: rituximab-cyclophosphamide combination (11.9%), cyclophosphamide (26.2%), standard-dose rituximab (39.6%), and low-dose rituximab (22.3%). Serious infection requiring hospital readmission occurred in 27% of patients within the first year, with rates of 37.5%, 23.8%, 25.8%, and 31.6% across the respective treatment groups. One-year mortality was 20% overall (by treatment group: 10%, 23%, 14%, and 26%). Increasing age was associated with higher mortality (HR 4.15, 95% CI 1.62-10.6), but not with serious infection (HR 1.18, 95% CI 0.47-2.93). CONCLUSION: Considering the enrichment for hospitalised patients with severe disease and advanced age, a mortality rate of 20% at one year that is comparable to less severe and younger cohorts suggests tailoring remission induction strategy according to a holistic assessment of frailty and disease activity may partially mitigate the higher risk of infection and mortality with advancing age.
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| Authors | Mark E McClure, Ayonija Sundararajan, Karl Emil Nelveg-Kristensen, Maya Leibowitz, Matthew L. Coates, Dominic McGovern, Michael Chen-Xu, Iftach Sagy, Karol Graňák, Tom Quarrell, Shreehari Suresh, Martha Watson, Andreas Kronbichler, Lisa Willcocks, R.A. Smith, David R W Jayne, Rachel B Jones |
| Journal | Lara D. Veeken |
| Year | 2026 |
| DOI |
10.1093/rheumatology/keag275
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| URL | |
| Keywords | Keywords not found |
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