Skip to main content

Duration of Azathioprine Maintenance in AAV Does Not Alter Relapse Rates

A European multicentre study examined whether the duration of azathioprine (AZA) maintenance therapy in ANCA-associated vasculitis patients would influence the relapse rate during long-term follow-up.

Investigators enrolled 380 ANCA-associated vasculitis patients currently treated with AZA maintenance therapy. The diagnoses were primarily granulomatosis with polyangiitis (n = 236) but also included microscopic polyangiitis (n = 132) and renal limited vasculitis ( n = 12). 

There were 84 first relapses while on AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months).

In those who stopped AZQ, there were 20 relapses in the first 12 months (1 relapse/119 months) and 29 relapses beyond 12 months after withdrawal (1 relapse/186 months).

Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was more likely in those based on induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative).

It appears that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months does not alter relapse-free survival rates. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.

ADD THE FIRST COMMENT

If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

Disclosures
The author has no conflicts of interest to disclose related to this subject