scholarly journals AB0388 USE OF MESNA PROPHYLAXIS IN CYCLOPHOSPHAMIDE-TREATED PATIENTS WITH ANCA-ASSOCIATED VASCULITIS: RESULTS OF AN ELECTRONIC SURVEY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1222.1-1222
Author(s):  
L. Joos ◽  
S. Gonzalez Chiappe ◽  
T. Neumann ◽  
A. Mahr
Keyword(s):  
Clinical Practice ◽  
Pulse Therapy ◽  
Mesh Term ◽  
Online Information ◽  
Omnibus Test ◽  
Medical Specialties ◽  
Electronic Survey ◽  
Anca Associated Vasculitis ◽  
Monitoring Therapy ◽  
Response Variables

Background:Co-prescribing 2-mercaptoethane sodium sulfonate (mesna) with cyclophosphamide (CYC) for ANCA-associated vasculitis (AAV) aims to prevent the potential urotoxic effects of CYC. The evidence for this practice is often considered weak, and there may be some diversity in what practitioners do in clinical practice.Objectives:To investigate current clinical practice related to prescribing mesna prophylaxis or not and the underlying rationale for CYC-treated patients with AAV.Methods:We searched MEDLINE for publications with the MeSH term “ANCA-associated vasculitis” over a 10-year period up to October 2020. Email addresses of authors of these publications were extracted from the online information available in MEDLINE. These authors were invited by email to participate in an anonymous online SurveyMonkey survey of 21 to 24 questions asking about the characteristics of the respondent, their experience with AAV, and their practice in using CYC to treat AAV and using mesna in CYC-treated patients with AAV and the underlying rationale. Respondents were eligible to take the full survey if they were involved in deciding and/or monitoring therapy with CYC for patients with AAV. We compared 15 response variables to identify factors associated with the use or not of mesna. Response variables with multiple categories were first analyzed across all categories; if the omnibus test result was significant, additional analyses were used to identify the categories, which were the sources of group separation. We analyzed by-country variations for only countries with ≥ 10 respondents. Statistical analyses involved Pearson’s chi-square test or Fisher’s exact test, as appropriate. For multiple-response variables, the Rao-Scott correction was applied.Results:The invitation for the electronic survey was emailed twice in October 2020 to 1,374 unique email addresses; 156 individuals responded; 139 were eligible and completed the survey. The 139 participants were from 34 countries and were essentially MDs (98%) who mainly worked in rheumatology (50%), nephrology (25%) or internal medicine/clinical immunology (18%). Mesna was given in conjunction with CYC systematically, never, or on a case-by-case basis by 68%, 19% and 13% of respondents, respectively. As compared with systematic mesna-prescribers, never/occasional mesna-prescribers reported a longer time since receiving their degree as a health professional (≥ 15 years: 80% vs 50%, P<0.001), were more frequently based in England/United States (than in France/Germany/Italy) (78% vs 21%, P<0.001), had longer involvement in care of patients with AAV (≥ 15 years: 62% vs 37%, P=0.006), had less practice in using intermittent pulse therapy as the exclusive/predominant CYC administration scheme (62% vs 89%, P<0.001), and, as a rationale underpinning their mesna practice, had less adherence to local operational procedures (47% vs 73%, P=0.002) or (inter)national management guidelines for AAV (16% vs 49%, P<0.001). Never/occasional versus systematic use of mesna did not differ across medical specialties (5 categories, P=0.192) or healthcare settings (3 categories, P=0.437), and was not associated with prior experience of CYC-related urotoxic events (3 categories, P=0.495) or severe mesna toxicity issues (3 categories, P=0.957). The confidence that their practice reflected the best possible patient care did not differ between never/occasional and systematic mesna-prescribers (7-point Likert scale, P=0.794).Conclusion:Practice with regard to prescribing mesna in conjunction with CYC to treat AAV is heterogeneous, although systematic mesna use prevailed over never or occasional use. The decision to prescribe or not mesna may be based more on circumstantial than structural reasons.Disclosure of Interests:Lukas Joos: None declared, Solange Gonzalez Chiappe: None declared, Thomas Neumann Speakers bureau: GSK, Grant/research support from: Xifor, Alfred Mahr Speakers bureau: Amgen, Celgene, Roche, Chugai, Consultant of: Amgen, Celgene, Roche, Chugai

scholarly journals ANCA Testing in Clinical Practice: From Implementation to Quality Control and Harmonization

2021 ◽  
Vol 12 ◽  
Author(s):  
Jan Damoiseaux
Keyword(s):  
Quality Control ◽  
Clinical Practice ◽  
Small Vessel Vasculitis ◽  
Clinical Relapse ◽  
Implementation Quality ◽  
Current Review ◽  
Anca Associated Vasculitis ◽  
Monitoring Therapy ◽  
Diagnostic Work ◽  
Work Up

Analyses for the presence of anti-neutrophil cytoplasmic antibodies (ANCA) are important in the diagnostic work-up of patients with small vessel vasculitis. Since current immuno-assays are predominantly designed for diagnosis of patients with ANCA-associated vasculitis (AAV), implementation in routine clinical practice, internal and external quality control, and harmonization are focused on this particular use. However, ANCA testing may also be relevant for monitoring therapy efficacy and for predicting a clinical relapse in AAV patients, and even for diagnostic purposes in other clinical situations. In the current review, the topics of implementation, quality control, and standardization vs. harmonization are discussed while taking into account the different applications of the ANCA assays in the context of AAV.

scholarly journals AB0882-HPR ANCA-ASSOCIATED VASCULITIS: A CLINICAL PRACTICE ASSESSMENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1464.2-1465
Author(s):  
S. Mendly ◽  
G. Boutsalis
Keyword(s):  
Clinical Practice ◽  
Clinical Trial Data ◽  
Trial Data ◽  
Remission Induction ◽  
Refractory Disease ◽  
Maintenance Strategy ◽  
Combination Therapies ◽  
Research Support ◽  
Educational Grant ◽  
Anca Associated Vasculitis

Background:AAV (ANCA-associated vasculitis) is a group of progressive, rare, severe autoimmune diseases1,2. AAV can affect blood vessels in different parts of the body resulting in damage to vital organs such as the lungs, kidneys, nervous system, gastrointestinal system, skin, eyes, and heart.2 There are currently no approved therapies for remission-induction in patients with AAV. The current treatment armamentarium for AAV is comprised of various immunosuppressive therapies in combination with steroid treatment. Understanding clinical practice gaps in the management of AAV, can inform development of tools to improve physician practices.Objectives:This medical education activity aims to assess physicians’ knowledge on the various manifestations of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), current guideline-recommended treatment strategies for remission induction in patients with AAV, as well as recent clinical trial data for combination therapies used for remission induction.Methods:A 24-question survey consisting of multiple-choice knowledge and case-based questions was made available to nephrologists and rheumatologists without monetary compensation or charge. The questions were designed to evaluate knowledge regarding the various manifestations of AAV and the results from clinical trials that have compared the efficacy of combination therapies used for remission induction in patients with AAV. As well as application of guideline-recommended therapies and clinical trial data for remission induction in patients with AAV within clinical practice. The survey launched online on a website dedicated to continuous professional development. (www.medscape.org/viewarticle/920320) on July 15, 2020. Data were collected until October 1, 2020.Results:363 nephrologists and 190 rheumatologists completed the survey. Physicians demonstrated gaps in the following areas:TopicIncorrect Responses to Knowledge and Clinical Decision-Making Questions (%)NephrologistsRheumatologistsSystemic diseases associated with AAV59%45%How to confirm diagnosis of AAV42%25%Therapy selection to induce remission that would be consistent with guidelines recommendations71%51%Guideline-recommended therapy for patients that do not respond to the induction regimen32%34%Definition of refractory disease95%94%Most effective maintenance strategy for a patient once remission is achieved80%64%Where would an emerging therapy such as a C5a receptor inhibitor fit into the therapeutic armamentarium of AAV?62%47%What are the guideline-recommended therapies to reduce remission in patients without organ-threatening disease?71%51%Most effective maintenance strategy for a patient once remission is achieved80%64%Guideline-recommendations on length of time to continue maintenance therapy31%35%Conclusion:This educational research on assessment of physicians’ (nephrologists and rheumatologists) clinical practices yielded important insights into clinical gaps related to understanding of the disease pathophysiology and progression of AAV, guideline recommendations on diagnosing and managing AAV with guideline-directed medical therapies (GDMTs), strategies for the management of relapsing and refractory disease in AAV and positioning of emerging therapies in the treatment paradigm.References:[1]www.medscape.org/viewarticle/920320.[2]Hutton HL, et al. Semin Nephrol 2017;37(5):418–35.[3]Al-Hussain T, et al. Adv Anat Pathol 2017;24(4):226–34.Disclosure of Interests:Sarah Mendly Grant/research support from: Supported by an independent educational grant from Vifor Pharma, George Boutsalis Grant/research support from: Supported by an independent educational grant from Vifor Pharma

Therapies for Onychomycosis

2015 ◽  
Vol 105 (4) ◽  
pp. 357-366 ◽  
Author(s):  
Aditya K. Gupta ◽  
Deanne Daigle ◽  
Maryse Paquet
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Treatment Efficacy ◽  
Meta Analysis ◽  
Pulse Therapy ◽  
Controlled Trials ◽  
Review Of The Literature ◽  
Mycological Cure ◽  
Randomized Controlled ◽  
Topical Treatments

New therapies for onychomycosis continue to be developed, yet treatments are seldom directly compared in randomized controlled trials. The objective of this study was to compare the rates of mycological cure for oral and topical onychomycosis treatments using network meta-analysis. A systematic review of the literature on onychomycosis treatments published before March 25, 2013, was performed, and data were analyzed using network meta-analysis. Terbinafine, 250 mg, therapy was significantly superior to all treatments except itraconazole, 400 mg, pulse therapy; itraconazole, 200 mg, therapy was significantly superior to fluconazole and the topical treatments; and fluconazole, efinaconazole, ciclopirox, terbinafine nail solution, and amorolfine treatments were significantly superior to only placebo. These results support the superiority of 12-week continuous terbinafine, 250 mg, therapy and itraconazole, 400 mg, pulse therapy (1 week per month for 3 months) while suggesting the equivalence of topical therapies. These results reflect findings from the literature and treatment efficacy observed in clinical practice.

CONCEPTUALIZATION OF THE DIAGNOSED CLINICAL SITUATION COMPONENTS FOR ELECTRONIC MONITORING OF THE TREATMENT QUALITY

2021 ◽  
Vol 67 (1) ◽  
pp. 10-10
Author(s):  
T.K. Lugovkina ◽  
Keyword(s):  
Clinical Practice ◽  
Care Delivery ◽  
The State ◽  
Information Environment ◽  
Medical Specialties ◽  
Philosophical Foundations ◽  
Conceptual Schemes ◽  
Quality Of Treatment ◽  
General Terms

Significance. Free care delivery within the framework of the State Guarantee Programs substantiates the development of electronic platforms for information support of doctors in prescribing medicines and monitoring quality of treatment. Conceptualization of the unified information environment of clinical practice, unified interpretation of the terms and components of the diagnosed clinical situations are important conditions for effective performance of the medical electronic platforms. Purpose: to conceptualize the scheme of information environment of clinical practice to support decision-making and monitor quality of treatment. Material and methods. The conceptual schemes of the information environment of clinical practice have been developed in accordance with the system principles. The methodology for constructing conceptual schemes is based on the general principles of philosophical foundations of science. Results. The conceptual schemes, conceptual apparatus, and information environment of structural elements of the model of information environment of clinical practice have been developed. A glossary of general terms and concepts of the information environment of clinical practice has been created. The structural model of information environment was tested at the prototype electronic platforms across different medical specialties. Conclusion. The use of ontologies and intelligent systems based on the expert knowledge in combination with digital coding of the diagnosed clinical situations serve a promising approach to monitor and control quality of care delivery and cost accounting within the framework of the State Guarantee Programs implementation. Scope of application. The concepts of the components of the diagnosed clinical situations meet the requirements of the interdisciplinary level of the information environment and are applicable for creating electronic platforms in various specialized areas of clinical practice.

scholarly journals A view into clinical practice guidelines: who uses them, who doesn’t and possibly, why

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Mihaela C. Munteanu ◽  
Julie Choi Jordan
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Healthcare Providers ◽  
Medical Professional ◽  
Physician Attitudes ◽  
Negative Consequences ◽  
Access To Treatment ◽  
Medical Specialties ◽  
And Behavior

Medical professional societies each develop specific clinical practice guidelines (CPGs). Based on the best available evidence, CPGs are intended to control variability and optimize quality of care in clinical practice. Yet, healthcare providers often do not accept or adhere to guidelines, but their reasons are not fully understood. When providers opt to choose not to follow CPGs, unfavorable patient outcomes including unequal access to treatment become negative consequences. In this small qualitative study, we will explore what causes non-adherence to CPGs and what changes have been made to CPGs from when physicians completed their medical residencies to the present. We interviewed physicians from a variety of medical specialties to assess how these changes may influence guideline adherence as well as the consequences of not following them. We found that guidelines may not be followed in cases where patients have comorbidities that are not described in the guidelines or when physicians do not incorporate new evidence and technology advances into their practice. In some specialties, physicians can develop a poor reputation if they do not adhere to the CPGs, and managed care agencies may deny reimbursement for care they provided. To best serve the physician and the patient, we need to find ways to improve CPG adherence. Tactics such as improving the methodology of CPG formation, using information technology, and creating ways to change physician attitudes and behavior are all viable options.

Treatment of autoimmune ophthalmopathy syndrome

1993 ◽  
Vol 74 (4) ◽  
pp. 293-294
Author(s):  
V. V. Talantov ◽  
E. N. Khasanov ◽  
R. L. Shamsutdinova ◽  
I. F. Gilmullin
Keyword(s):  
Clinical Practice ◽  
Pulse Therapy ◽  
High Doses

The treatment of autoimmune ophthalmow pathy by the high doses (pulse-therapy) or glucocorticoids in terms of interrupted courses (3 days cycles in every 710 days and in 1 1,5 months later on) may be successfully used in clinical practice. Pulse-therapy in the treatment of autoimmune ophthalmopathy syndrome is primarily recommended in the heavy course of the disease. Roentgenotherapy on the orbit region is prescribed in case of the insufficient effect.

Managing cancer care through service delivery networks: The role of professional collaboration in two European cancer networks

2017 ◽  
Vol 31 (3) ◽  
pp. 120-129 ◽  
Author(s):  
Joan Prades ◽  
Verdiana Morando ◽  
Valeria D Tozzi ◽  
Didier Verhoeven ◽  
Jose R Germà ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Work ◽  
Network Governance ◽  
Governance Structures ◽  
Medical Specialties ◽  
Strategic Networks ◽  
Services Delivery ◽  
Four Levels ◽  
Cancer Networks ◽  
European Cancer

Background The study examines two meso-strategic cancer networks, exploring to what extent collaboration can strengthen or hamper network effectiveness. Unlike macro-strategic networks, meso-strategic networks have no hierarchical governance structures nor are they institutionalised within healthcare services’ delivery systems. This study aims to analyse the models of professional cooperation and the tools developed for managing clinical practice within two meso-strategic, European cancer networks. Methods Multiple case study design based on the comparative analysis of two cancer networks: Iridium, in Antwerp, Belgium and the Institut Català d’Oncologia in Catalonia, Spain. The case studies applied mixed methods, with qualitative research based on semi-structured interviews ( n = 35) together with case-site observation and material collection. Results The analysis identified four levels of collaborative intensity within medical specialties as well as in multidisciplinary settings, which became both platforms for crosscutting clinical work between hubs’ experts and local care teams and the levers for network-based tools development. The organisation of clinical practice relied on professional-based cooperative processes and tiers, lacking vertical integration mechanisms. Conclusions The intensity of professional linkages largely shaped the potential of meso-strategic cancer networks to influence clinical practice organisation. Conversely, the introduction of managerial techniques or network governance structures, without introducing vertical hierarchies, was found to be critical solutions.

scholarly journals Estudio piloto para la valoración del equilibrio en mujeres adultas con un elemento cinemático (Balance assessment in adult women with a cinematic element: a pilot study)

Retos ◽  
2015 ◽  
pp. 90-93
Author(s):  
Raquel Leirós Rodríguez ◽  
Mª Elena Arce Fariña ◽  
José Luis García Soidán
Keyword(s):  
Clinical Practice ◽  
Assessment Tool ◽  
Dynamic Balance ◽  
Low Cost ◽  
Spinous Process ◽  
The Body ◽  
Future Research ◽  
Adult Women ◽  
Medical Specialties ◽  
Wide Range

En este trabajo se valora el equilibrio a través de una amplia gama de condiciones de valoración cinemáticas para poder contrastarlos posteriormente con pruebas de equilibrio vigentes en la práctica clínica. Todo ello con el objetivo de conseguir una medida holística del equilibrio e identificar con mayor fiabilidad qué sistemas subyacentes están más presentes en cada una de las pruebas. Se valoraron un total de 30 mujeres con una media de edad de 63.07 años (DT = 6.06) con un instrumento de medición cinemático triaxial a la altura de la apófisis espinosa de L4 durante la realización de diferentes pruebas de equilibrio estático y dinámico. Los resultados mostraron que a medida que las tareas solicitadas aumentaban en complejidad, las variaciones de velocidad se hacían más amplias y complejas. A su vez, se encontraron correlaciones con la edad y el resultado obtenido previamente en la prueba Timed Up & Go, lo que confirma la correspondencia entre las variaciones de velocidad del tronco y el estado de los sistemas de control postural. Este instrumento se ha reafirmado como una herramienta de valoración única por su capacidad de reconocer y registrar el comportamiento natural del cuerpo en combinación con su bajo coste. Ambos aspectos lo hacen potencialmente útil en la práctica clínica de diferentes especialidades médicas. Ampliar la muestra del estudio así como cotejar los datos extraídos de las mediciones cinemáticas con otras variables fisiológicas y antropométricas, se sugieren como posibles mejoras en investigaciones futuras.Abstract. This paper assesses the balance through a wide range of kinematic conditions assessment for later compare them with existing balance tests in clinical practice. The goal was to achieve a holistic measure of balance and more reliably identify what underlying systems are present in each of the tests. A total of 30 women with a mean age of 63.07 years (SD = 6.06) were evaluated with a triaxial instrument at the height of the spinous process of L4 while performing different tests of static and dynamic balance kinematic measurement. The results showed that as the required tasks increased in complexity, speed variations became larger and more complex. In turn, correlations were found with age and the result obtained previously in the Timed Up & Go test, confirming the correspondence between the velocity variations of the trunk and the state of postural control systems. This instrument has been reaffirmed as a single assessment tool for its ability to recognize and record the natural behavior of the body in combination with low cost. Both aspects make it potentially useful in clinical practice in different medical specialties. Larger study sample and collate data from the kinematic measurements with other physiological and anthropometric variables are suggested as possible improvements in future research.

scholarly journals ANCA-associated vasculitis in a 14 years-old patient: a clinical case

2020 ◽  
Vol 27 (5) ◽  
pp. 184-194
Author(s):  
A. V. Burlutskaya ◽  
N. V. Savelyeva ◽  
N. S. Тaran
Keyword(s):  
Respiratory Failure ◽  
Immunosuppressive Therapy ◽  
Clinical Case ◽  
Granulomatosis With Polyangiitis ◽  
Systemic Vasculitis ◽  
Pulse Therapy ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Anca Associated Vasculitis ◽  
Nasal Bleeding ◽  
Diagnostic Research

Background. ANCA-associated systemic vasculitis is a rare childhood disease. Antineutrophil cytoplasmic autoantibodies (ANCA)-related vasculitises include microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. Their rarity often leads to a late diagnosis, rapid disability and high mortality in patients due to aggressive respiratory, pulmonary lesion and renal failure.Clinical Case Description. The patient suffered from a recurrent bronchoobstructive syndrome with signs of respiratory failure, obscure origin fever and chronic rhinitis with nasal bleeding for 6 months. The patient was diagnosed with obstructive bronchitis (putative bronchial asthma debut), received antibacterial therapy and inhalation bronchodilators without stable improvement during the entire period. Skin haemorrhages and arthralgia stimulated diagnostic research to establish ANCA-associated systemic vasculitis (presence of proteinase 3-specifi c ANCAs in titre 1/80). CT lung scanning revealed frosted glass foci of reduced pulmonary pneumatisation and signs of bilateral bronchoobstruction. Immunosuppressive therapy with glucocorticosteroids (methylprednisolone pulse therapy No. 3, 1000 mg intravenously on alternate days, subsequent per os administration of 1 mg/kg/day) and cyclophosphamide (500 mg intravenously once per 28 days) was prescribed. This led to the positive dynamics with eliminated fever and skin haemorrhages, as well as essentially reduced signs of respiratory failure.Conclusion. Diagnosis of systemic vasculitis is often complicated and long-term due to commonly non-specifi c debut symptoms of autoimmune disorders. In the described case, the fi rst 6 months of illness displayed intoxication and bronchoobstruction with signs of respiratory failure. Haemorrhagic rashes, arthralgias and the presence of ANCAs are proxy to vasculitis. Standard immunosuppressive therapy for ANCA-associated vasculitis improved the patient’s condition.

THU0304 CLINICAL PRACTICE VARIATION BETWEEN ACADEMIC AND NON-ACADEMIC CENTERS IN THE MANAGEMENT OF ANCA ASSOCIATED VASCULITIS IN THE NETHERLANDS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 380-381
Author(s):  
E. Dirikgil ◽  
A. Rutgers ◽  
S. Tas ◽  
C. A. Verburgh ◽  
D. Soonawala ◽  
...  
Keyword(s):  
Clinical Practice ◽  
The Netherlands ◽  
Induction Therapy ◽  
Granulomatosis With Polyangiitis ◽  
Practice Variation ◽  
Oral Cyclophosphamide ◽  
Research Support ◽  
Anca Associated Vasculitis ◽  
Academic Hospitals ◽  
Number Of Patients

Background:ANCA associated vasculitis (AAV) is a complex, rare systemic autoimmune disease with an estimated prevalence of 5-18 patients per 100.000 individuals worldwide. Managing a low prevalent disease can be challenging which is reflected in clinical practice variation.Objectives:This study investigated clinical practice variation of the care for AAV patients in the Netherlands.Methods:In a nationwide online survey, AAV patients were selected from academic and non-academic centers. Within centers, patients were eligible when they had a confirmed diagnosis of microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) or eosinophilic granulomatosis with polyangiitis (eGPA) according to the treating physician. There were no exclusion criteria. In each center a comparable number of patients was included. Data capture encompassed a wide set of variables on diagnosis, management and outcomes.Results:From December 2018 to November 2019, 230 AAV patients were recruited in 6 non-academic and 3 academic hospitals (120 vs 110 patients respectively). Differences in clinical diagnoses (GPA, MPA and eGPA) were observed between non-academic and academic centers (p=0.05), which was mainly caused by a higher number of MPA patients in non-academic centers. The year of diagnosis was comparable (median 2013 [2009-2016], p=0.150). The median follow up since diagnosis was 4.8 years [1.8-9.6] with a median in-hospital time-to-diagnosis of 13 days [2-50]. Patients were diagnosed at a mean age of 63 years (±11.18) in non-academic centers and 53 years (±16.92) in academic centers (p<0.001). Besides steroids, oral cyclophosphamide was the most preferred drug (54%) for induction therapy, whereas rituximab was given significantly more often as (part of the) induction therapy in patients treated in academic centers compared to patients in non-academic centers (27% vs 8%, p<0.001). In non-academic centers pneumocystis pneumonia (PCP) prophylaxis was prescribed significantly less (76% vs 91%, p=0.003). Also, screening for Staphylococcus aureus carriership was significantly less (17% vs 68%, p<0.001). With respect to mortality and co-morbidity, 22 patients (10%) died, 100 patients (44%) had at least one infection and 24 patients (10%) suffered from at least one malignancy. We observed no significant differences on these endpoints between academic and non-academic centers.Conclusion:The present study highlights important practice variation in the management of AAV between academic and non-academic hospitals in the Netherlands. A high proportion of patients is treated with oral cyclophosphamide as induction therapy while rituximab is increasingly used in academic centers. Rates of mortality, infections and malignancies were not different. Altogether, this study raises awareness into the variation of management for AAV patients and allows the identification of areas for improvement of clinical care for Dutch AAV patients.Disclosure of Interests:Ebru Dirikgil: None declared, Abraham Rutgers: None declared, Sander Tas: None declared, Cornelis A. Verburgh: None declared, Darius Soonawala: None declared, A. Elisabeth Hak: None declared, Hilde H.F. Remmelts: None declared, Daphne IJpelaar: None declared, Gozewijn D. Laverman: None declared, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS, H.J. Bernelot Moens: None declared, Peter Verhoeven: None declared, Willem Jan W. Bos: None declared, Y.K. Onno Teng Grant/research support from: GSK, Consultant of: GSK, Aurinia Pharmaceuticals, Novartis

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