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The effect of discontinuation of maintenance therapy in Chinese patients with MPO-ANCA associated vasculitis who were in long-term stable remission

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Abstract

There is a consensus that maintenance therapy should be used to prevent relapse of myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (MPO-AAV), but there is a debate about the optimal duration of maintenance therapy. Therefore, the purpose of this study was to determine whether discontinuation of maintenance therapy in MPO-AAV patients who were in long-term stable remission affects relapse, renal survival and patient survival. Seventy-nine patients with MPO-AAV diagnosed at Xiangya hospital from June 2010 to June 2019 who were in stable remission for at least 18 months following maintenance therapy were included. Patient records were retrospectively reviewed, and based on whether patients discontinued maintenance therapy 18 months after commencing maintenance therapy, patients were assigned into either the withdrawal group (n = 26) or maintenance group (n = 53). The endpoint was the percentage of relapse, relapse-free survival, renal survival and patient survival during follow-up. Ten relapses (38.5%) occurred in the withdrawal group (n = 26) and 8 relapses (15.1%) occurred in the maintenance group (n = 53) (p = 0.020). Compared to the withdrawal group, the maintenance group had similar relapse-free survival (log-rank test p = 0.099). But maintenance group had a better renal survival (p = 0.035), with no difference in patient survival or adverse events. This study suggests that discontinuing maintenance therapy at 18 months following induction of sustained remission leads to a significant increase in the percentage of relapse, and decreases renal survival in patients with MPO-AAV, but does not decrease relapse-free survival or patient survival.

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Funding

This work was funded by the National Key Research and Development Program of China (2020YFC2005000 to XX), the Key Research and Development Program of Hunan province (2018WK2060 to XX and 2020WK2008 to YZ), the National Natural Science Foundation of China (81800641 to TM), Chinese Society of Nephrology (18020010780 to YZ), the Natural Science Foundation of Hunan Province (2021JJ31130 to YZ, 2020JJ6109 to CS and 2019JJ40515 to WN), the science and technology innovation Program of Hunan Province (2020RC5002 to JO), Scientific research program of traditional Chinese medicine in Hunan Province (201761 to XL), “Yiluqihang Shenmingyuanyang” medical development And Scientific Research Fund project on Kidney Diseases (SMYY20220301001 to YZ).

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Authors and Affiliations

  1. Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China

    Peng Zhu, Ting Meng, Joshua D. Ooi, Rong Tang, Xiang Ao, Weisheng Peng, Zhou Xiao, Wannian Nie, Xia Li, Qiaoling Zhou, Ping Xiao, Yong Zhong & Xiangcheng Xiao

  2. Department of Hematology, The Affiliated Zhuzhou Hospital Xiangya Medical College, Central South University, Zhuzhou, China

    Chanjuan Shen

  3. Centre for Inflammatory Diseases, Monash Medical Centre, MonashUniversity Department of Medicine, Clayton, VIC, Australia

    Joshua D. Ooi & Peter J. Eggenhuizen

  4. Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China

    Ya-Ou Zhou & Hui Luo

  5. Department of Medical Records and Information, Xiangya Hospital, Central South University, Changsha, China

    Jin-Biao Chen

  6. Department of Pathology, Xiangya Hospital, Central South University, Changsha, China

    Wei Lin

Authors
  1. Peng Zhu
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  2. Ting Meng
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Correspondence to Yong Zhong or Xiangcheng Xiao.

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The study was retrospective and did not require written informed consent. This study was in compliance with ethical standards. The Ethic Committee of Xiangya Hospital approved the study protocol according to the Declaration of Helsinki (ID: 201711836).

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Zhu, P., Meng, T., Shen, C. et al. The effect of discontinuation of maintenance therapy in Chinese patients with MPO-ANCA associated vasculitis who were in long-term stable remission. Clin Exp Med 23, 357–364 (2023). https://doi.org/10.1007/s10238-022-00807-2

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  • DOI: https://doi.org/10.1007/s10238-022-00807-2

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