Predictors of early relapse in patients with non-infectious mixed cryoglobulinemia vasculitis: results from the French nationwide CryoVas survey.

Abstract

OBJECTIVE:

Although in most patients induction therapy leads to complete or partial remission, relapses in patients with non-infectious mixed cryoglobulinemia vasculitis (CryoVas) remain a major problem. We aimed to identify predictors of early relapses occurring within the first 12months of treatment in such patients.

METHODS:

Patients included in the French CryoVas survey exhibiting complete/partial clinical remission and followed-up for at least 12months after induction therapy (n=145) were analyzed for predictors of early relapses.

RESULTS:

Forty out of 145 patients (28%) experienced early relapse. Relapses occurred after a median time of 9.5months after induction therapy (3-12) and involved skin (75%), joints and peripheral nerve (28% each), kidneys (25%) and gastrointestinal tract (5%). Baseline factors associated with an early relapse were purpura [HR 3.35 (1.02-10.97), P=0.046], cutaneous necrosis [HR 4.46 (1.58-12.57), P=0.005] and articular involvement [HR 2.20 (1.00-4.78), P=0.048]. The only factor negatively associated with an early relapse during follow-up was the achievement of complete immunological response [HR 0.07 (0.01-0.51), P=0.009]. The use of corticosteroids plus rituximab or cyclophosphamide tended to be associated negatively with early relapse [HR 0.43 (0.17-1.08), P=0.07].

CONCLUSION:

In patients with non-infectious CryoVas, main predictors of early relapses after initial remission are purpura, articular involvement, and cutaneous necrosis. The absence of complete immunological response during follow-up was associated with early relapse. These findings may help in adapting future treatment strategies.

• Authors: Benjamin Terrier, Isabelle Marie, David Launay, Adeline Lacraz, Pauline Belenotti, Luc de Saint-Martin, Thomas Quemeneur, Antoine Huart, Fabrice Bonnet, Guillaume Le Guenno, Jean-Emmanuel Kahn, Olivier Hinschberger, Patricia Rullier, Elisabeth Diot, Estibaliz Lazaro, Frank Bridoux, Thierry Zénone, Fabrice Carrat, Olivier Hermine, Jean-Marc Léger, Xavier Mariette, Patricia Senet, Emmanuelle Plaisier, Patrice Cacoub
• Journal: Autoimmunity reviews (Autoimmun Rev) Vol. 13 Issue 6 Pg. 630-4 (Jun 2014) ISSN: 1873-0183 [Electronic] Netherlands
• PMID: 24418300 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2014 Elsevier B.V. All rights reserved.

Topics

• Cryoglobulinemia (complications, drug therapy, immunology)
• Follow-Up Studies
• France
• Humans
• Recurrence
• Remission Induction
• Vasculitis (complications, diagnosis, drug therapy, immunology)