Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Systemic Necrotizing Vasculitides in the Elderly: Baseline Data on the 101 Patients 65 Years Old Enrolled in the CORTAGE Multicenter Trial.

Pagnoux8,  Christian, Rollot9,  Florence, Quemeneur7,  Thomas, Ninet4,  Jacques, Diot3,  Elisabeth, Kyndt7,  Xavier, de Wazieres12,  Benoît

Centre Hospitalier Du Mans, Le Mans, France
Medecine Interne, Centre Hospitalier Bretagne-Atlantique, BP 70555 56017 VANNES
Medecine Interne, CHU Bichat, Paris Diderot
Medecine Interne, CHU de Nimes
Service de Medecine Interne. CHU Robert Debré. Avenue du Général Koenig. 51092 REIMS
URC Cochin Tarnier, Paris Descartes
CH Béziers - Narbonne
CHRU TOurs, Medecine Interne
CHU de Lyon - Hôpitale Edouard Herriot, Médecine Interne-Pathologie Vasculaire
France
Hopital Cochin-Paris Univ, Paris, France
Internal Medicine, CH Valenciennes
Internal Medicine, Hopital Cochin, APHP, Universite Paris Descartes
Internal Medicine, Hopital Cochin, APHP, Universite Paris Descartes

Objective:

To analyze baseline characteristics of patients with systemic necrotizing vasculitides (SNV; polyarteritis nodosa (PAN), Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), Churg–Strauss syndrome (CSS)) enrolled in the corticosteroid-based treatment for SNV patients aged >=65 yr (CORTAGE) trial.

Methods:

We analyzed their baseline clinical and biological manifestations, i.e., at diagnosis. At that time, patients were classified according to their prognostic five-factor score (FFS) and randomized to receive conventional treatment (corticosteroids alone for ~28 months for CSS or PAN patients with FFS=0; or combined with 500-mg/m2 cyclophosphamide pulses every 2 wk for the first 3 pulses then every 3 wk until remission, for WG or MPA patients, and CSS or PAN patients with FFS>=1, then switched to azathioprine or methotrexate for maintenance) or the experimental regimen (for all patients, corticosteroids for ~9 months, combined with cyclophosphamide pulses at a fixed 500-mg dose every 2 wk for the first 3 pulses then every 3 wk until remission, and switched after a maximum of 6 pulses to azathioprine or methotrexate for maintenance). The CORTAGE primary endpoint is morbidity at 3 years.

Results:

Between July 2005 and February 2008, 108 patients were randomized; 7 were excluded (early consent withdrawn, protocol violation, wrong diagnosis). Mean age at diagnosis of the 101 analyzed patients (54 males, 47 females; 8 PAN, 12 CSS, 34 WG, 47 MPA) was 75.3 ± 6.3 yr, with a maximum of 92 years for 1 MPA patient. Sixteen PAN or CSS patients had FFS=0 (7/8 PAN, 9/12 CSS). Complete data on clinical features at diagnosis were comparably distributed between arms: 50 (50%) with fever, 36 (36%) arthralgias, 58 (57%) lung (15 nodules, 16 alveolar hemorrhages, 4 ARDS), 37 (37%) ENT, 20 (20%) GI, 18 (18%) heart (4 severe cardiac insufficiencies), 16 (16%) skin purpura, 13 (13%) ophthalmological (5 episcleritises), 24 (24%) PNS and 3 (3%) CNS manifestations. Mean creatinine was 236±210 mmol/l (61 microscopic hematuria, 8 initially required dialysis). Mean hemoglobin level was 10.2±2.0 g/dl, neutrophils 8538±4098/mm3, lymphocytes 1452±674/mm3, C-reactive protein 103±89 mg/l, albumin 28.0±6.3 g/l.

Seven (6.9%; 4 conventional-arm, 3 experimental-arm) patients died during induction. All had received cyclophosphamide: 4 (3 MPA, 1 WG) died of SNV progression, 2 (WG) of sepsis and 1 (MPA) of previously unknown cholangiocarcinoma.

Conclusion:

Despite having severe disease, as reflected by their high mean creatinine level at diagnosis, mortality of SNV patients >=65 years old included in the CORTAGE trial was relatively low during induction. Treatment-related morbidity and relapse rate remain to be determined (end of trial follow-up: April 2011).

To cite this abstract, please use the following information:
Pagnoux, Christian, Rollot, Florence, Quemeneur, Thomas, Ninet, Jacques, Diot, Elisabeth, Kyndt, Xavier, et al; Systemic Necrotizing Vasculitides in the Elderly: Baseline Data on the 101 Patients 65 Years Old Enrolled in the CORTAGE Multicenter Trial. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2045
DOI: 10.1002/art.29810

Abstract Supplement

Meeting Menu

2010 ACR/ARHP