OBJECTIVES: AAV is a severe systemic vasculitis and rapid induction of remission is desirable. Therapy is a combination of high dose glucocorticoids (GC) with rituximab or cyclophosphamide. Treatment-related adverse events (AE) are common and contribute to long term organ damage and acute morbidity. This study examined clinical outcomes, AEs and resource use in incident AAV patients in routine clinical practice.

METHODS: RESULTS: Mean age was 56.82 years with 53.7% male. Comorbidities were common (hypertension 45%, diabetes 18%, COPD/asthma 15%, coronary arterial disease 10%, arthritis 9%, osteoporosis 7% and cardiac failure 6%) with only 32% having none. Resource use was significant with 68.9% of patients hospitalized (mean length of stay 17 days including 3 ICU days). Clinical response was assessed as full (no vasculitis activity and GC taper on track), partial (reduction in vasculitis activity), or no response (no improvement in vasculitis). Full response was variable (18%, 43%, 61%, and 59% at 1, 3, 6, and 12 months, respectively) and AEs common (corresponding patients experiencing at least one AE 45%, 42%, 35% and 30%). Many patients experienced at least one infection (27%, 28%, 23% and 20%); some required hospitalization due to vasculitis or infection (11.3% median 9.1 days, 9.8% 7.6, 8.3% 7.4, 5.7% 10.3). 16% commenced dialysis in month 1, 3% at 3 months, 1% at 6 and 12 months

CONCLUSIONS: Remission induction therapy has a variable response rate. Infections and AEs are common, especially in the first 3 months and there is significant healthcare resource use. New targeted therapy options are needed to improve response rates in AAV and reduce burden of therapy.