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Predictors of Treatment Resistance and Relapse in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: A Study of 439 Cases in a Single Chinese Center
Author(s) -
Li ZhiYing,
Chang DongYuan,
Zhao MingHui,
Chen Min
Publication year - 2014
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.38621
Subject(s) - medicine , hazard ratio , creatinine , erythrocyte sedimentation rate , gastroenterology , odds ratio , confidence interval , anti neutrophil cytoplasmic antibody , cyclophosphamide , vasculitis , chemotherapy , disease
Objective Treatment resistance and relapse in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) are major challenges for physicians. The aim of this study was to assess the risk factors for treatment resistance and relapse in a single‐center cohort of Chinese patients with AAV. Methods Four hundred thirty‐nine consecutive patients with AAV were recruited for inclusion in this study. The value of various clinical and pathologic parameters for the prediction of treatment resistance and relapse was analyzed. Results Treatment resistance occurred in 47 (10.7%) of 439 patients and was independently associated with a higher serum creatinine level (odds ratio [OR] 1.087, 95% confidence interval [95% CI] 1.001–1.180, P = 0.047), a higher erythrocyte sedimentation rate (OR 1.009, 95% CI 1.001–1.018, P = 0.025), therapy with corticosteroids plus cyclophosphamide (OR 0.115, 95% CI 0.051–0.256, P = 0.000), and the presence of muscle pain (OR 0.249, 95% CI 0.083–0.747, P = 0.013). Relapse occurred in 128 (32.7%) of 392 patients in whom remission was achieved and was independently associated with lung involvement (hazard ratio [HR] 1.768, 95% CI 1.088–2.872, P = 0.021) and a lower serum creatinine level (HR 0.925, 95% CI 0.872–0.981, P = 0.009). Conclusion In Chinese patients with AAV, lung involvement and lower serum creatinine levels were independently associated with an increased risk of relapse. Elevated serum creatinine levels were associated with treatment resistance.