Abstract
Background and Aims
ANCA associated vasculitis (AAV) treatment aims to quickly control vasculitis activity and then prevent relapse during the maintenance phase of this long term condition. Patients are at risk from disease and treatment related complications with high dose and/or long term glucocorticoid use being a major concern. This retrospective study examined adverse events, infections and healthcare resource use in patients managed in routine practice.
Method
1478 AAV patients (France, Germany, Italy, Spain and UK) managed by 493 physicians (61% Nephrologists) who completed induction therapy for new or relapsing organ or life threatening AAV and initiated maintenance therapy between 2014-16 were studied. Data were collected at the time maintenance was determined to begin by the physician and then at 6, 12, 18 and 36 months. 51% had microscopic polyangiitis, mean age 54.2 years with 56% male. BVAS was not used routinely but 56% had moderate systemic disease and 44% severe systemic disease at the time of start of induction remission treatment.
Results
78% patients had comorbidity (48% hypertension, 20% dylipidaemia, 17% type 2 diabetes mellitus, 14% depression, 13% COPD/asthma and 9% had BMI > 35) at induction treatment start. Maintenance was defined by physicians as starting approximately 6 months into treatment. AEs potentially linked to GCs were common (values are %, bp = hypertension, DM = diabetes mellitus) during the maintenance phase and many patients remained on long term glucocortioids. Infections were also common, in particular upper (URTI) and lower respiratory tract (LRTI) infection and urinary tract infections (UTI). Hospitilisations still occurred during maintenance period, in particular these are due to infections. Maintenance treatment varied and was changed over follow up (in 13-19% patients at each time point) and in a proportion of patients the change in treatment was precipitated by an adverse event or infection (6 months 21%, 12 months 22%, 18 months 23%, 38 months 26%).
Conclusion
Comorbidity is common in AAV patients and needs to be considered carefully when making treatment decisions. Patients receiving maintenance therapy frequently experience potentially GC related AEs and infections are also common. Healthcare resource use continues in the maintenance phase and this is on the background of comorbidity, less then complete remission rates and high use of long term steroids. New approaches are required to reduce clinical and healthcare system burdens during the maintenance treatment phase of AAV.
PCN101 - COSTS AND HEALTHCARE RESOURCE USE ASSOCIATED WITH MAINTENANCE THERAPY IN MULTIPLE MYELOMA: A SYSTEMATIC LITERATURE REVIEW
