Abstract: TH-PO507
Practice Patterns of Induction Therapy in Severe ANCA-Associated Vasculitis: An International Physician Survey
Session Information
- Glomerular Diseases: Clinical, Outcomes, Trials - I
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials
Authors
- Xu, Lillian, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Aqeel, Faten Faisal, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Tomar, Ojaswi Singh, Washington University in St Louis School of Medicine, St Louis, Missouri, United States
- Li, Tingting, Washington University in St Louis School of Medicine, St Louis, Missouri, United States
- Geetha, Duvuru, Johns Hopkins Medicine, Baltimore, Maryland, United States
Background
Therapies for ANCA-associated vasculitis (AAV) have evolved over the last 3 decades. In light of new data on plasma exchange (PLEX) and glucocorticoid (GC) use, as well as recent approval of avacopan (AVP), various medical societies have updated their AAV management guidelines. Here, we explored practice patterns of induction therapy in severe AAV and ascertained differences in management by physician specialty, practice setting, and volume of AAV patients.
Methods
A 65-item anonymous research survey addressing physician/practice characteristics, AAV induction therapy approaches, prophylactic measures, and laboratory monitoring was sent to physicians by e-mail and social media platforms after IRB approval. Practice patterns within the last 5 years were examined based on physician specialty, practice setting, and volume of AAV patients. Descriptive statistics, chi-square, t-test, and Fisher’s exact were used as appropriate.
Results
There were 308 responses (52% nephrologists, 41% rheumatologists). Of all participants, 29% practiced in the United States, 20% in India, 9% in the United Kingdom, 6% in Canada, and the remainder in other countries. Pulse methylprednisolone (MeP) was used by 94%, reduced dose GC by 70%, PLEX by 38%, rituximab (RTX) by 92%, cyclophosphamide (CYC) by 89%, and AVP by 12%. There were significant differences in use of reduced dose GC, PLEX, and RTX brand by physician specialty and by AAV patient volume (Table). Significant differences were seen in regards to pulse MeP dose (p<0.001), treatment of severe AAV presentations (p<0.001), CYC route and duration (p=0.005, p<0.001), and PJP prophylaxis (p<0.005) by physician specialty, RTX and AVP use by volume of AAV patients (p=0.003, 0.001), and CYC use by practice setting (p<0.001).
Conclusion
Our survey highlights significant differences in AAV induction therapy practices based on specialty, practice setting, and AAV patient volume. Additionally, one third of physicians continue to use standard GC.
| Physician Specialty | P-value | Volume of AAV Patients | P-value | |||
| Practice Patterns | Nephrology | Rheumatology | < 50/year | > 50/year | ||
| Use of reduced dose GC | 83% | 54% | <0.001 | 67% | 78% | 0.001 |
| Use of PLEX | 49% | 25% | <0.001 | 34% | 52% | 0.009 |
| Use of RTX brand | 35% | 17% | 0.001 | 32% | 13% | 0.009 |
| Use of AVP | 14% | 10% | 0.29 | 9% | 23% | 0.001 |
Funding
- Clinical Revenue Support