Z.S. Wallace, MD, MSc, Assistant Professor of Medicine, H.K. Choi, MD, DrPH, Professor of Medicine, Harvard Medical School, Clinical Epidemiology Program, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts;
H. Yun, PhD, Associate Professor, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
J Rheumatol. 2021 Jul;48(7):1060-1064. doi: 10.3899/jrheum.201330. Epub 2021 Feb 1.
The management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has evolved substantially over the last 2 decades. We sought to characterize AAV treatment patterns in the United States.
We identified patients with AAV in the Rheumatology Informatics System for Effectiveness (RISE) registry who had at least 2 rheumatology clinician visits between January 1, 2015, and December 31, 2017. Demographics, medications, laboratory test results, and billing codes were extracted from the medical record. Demographic and prescription trends were assessed overall and across US regions.
We identified 1462 patients with AAV, 259 (18%) with new or relapsing AAV. The majority were classified as having granulomatosis with polyangiitis (75%). The mean age was 59.8 years and 59% were female. The majority of patients were in the South (45%) followed by the Mid-West (32%), West (12%), and Northeast (8%). Patients had a median of 3 visits and follow-up of 579 days. The most commonly prescribed medications during the study period were glucocorticoids (86%) followed by rituximab (45%), methotrexate (33%), azathioprine (32%), and mycophenolate mofetil (18%); cyclophosphamide (CYC) was rarely used (7%). At the most recent visits in RISE, 47% of patients were on glucocorticoids. Prescription trends were similar across regions.
To our knowledge, this is the first study to evaluate the demographics and management of AAV by rheumatologists outside of major referral centers. Management strategies vary widely, but CYC is rarely used. These observations can be used to inform future research priorities. Additional studies are needed to characterize AAV severity in RISE as well as patient and provider treatment preferences.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）的治疗在过去 20 年中发生了重大变化。我们旨在描述美国 AAV 的治疗模式。
我们从 Rheumatology Informatics System for Effectiveness（RISE）登记处中确定了至少有 2 次就诊记录的 AAV 患者，这些就诊记录的时间范围为 2015 年 1 月 1 日至 2017 年 12 月 31 日。从病历中提取了人口统计学、药物、实验室检查结果和计费代码。评估了总体和美国各地区的人口统计学和处方趋势。
我们共确定了 1462 例 AAV 患者，其中 259 例（18%）为新发或复发 AAV。大多数患者被归类为肉芽肿性多血管炎（75%）。平均年龄为 59.8 岁，59%为女性。大多数患者在南部（45%），其次是中西部（32%）、西部（12%）和东北部（8%）。患者的中位数就诊次数为 3 次，随访时间为 579 天。研究期间最常开的药物是糖皮质激素（86%），其次是利妥昔单抗（45%）、甲氨蝶呤（33%）、硫唑嘌呤（32%）和霉酚酸酯（18%）；环磷酰胺（CYC）很少使用（7%）。在 RISE 的最近一次就诊中，47%的患者正在使用糖皮质激素。处方趋势在各地区相似。
据我们所知，这是首次在主要转诊中心以外的地方评估风湿病医生对 AAV 的诊治情况。管理策略差异很大，但很少使用 CYC。这些观察结果可用于为未来的研究重点提供信息。需要进一步研究以描述 RISE 中 AAV 的严重程度以及患者和提供者的治疗偏好。
