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.
McClure et al. (Fri,) studied this question.