title: Clinical outcomes of ANCA-associated vasculitis in elderly patients.
abstract: BACKGROUND
  Older age is independently associated with mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized that a reduced-dose immunosuppressive treatment would result in similar effectiveness and comparable treatment-related morbidity in elderly patients as the regular dose in younger patients. We also postulated that the higher baseline comorbidities may contribute to the higher mortality of the elderly subjects.
  
  
  METHODS
  Ninety-three consecutive patients with AAV between 1998 and 2012 were retrospectively analyzed. Forty-one individuals were defined as "elderly" (age >65 years) and 52 as "younger" (age <65 years). All cause and cardiovascular mortality, death due to vasculitis and infections, and effectiveness of "reduced-dose" immunosuppressive treatment in the elderly group were compared to the effects of "full-dose" treatment in younger individuals.
  
  
  RESULTS
  Mortality in the elderly group was higher (p = 0.007). Cardiovascular death was significantly increased (p = 0.002) in the elderly, but mortality due to vasculitis or infections was comparable. Treatment effectiveness was also similar in elderly and younger patients. At the end of the first follow-up year, 37 % of the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox regression analyses, being older than 65 year, having cardiovascular disease at baseline, need for dialysis at diagnosis, and lower serum albumin were associated with an increased hazard of mortality.
  
  
  CONCLUSIONS
  Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity.
authors.affiliation: Nephrology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary, agnesharis@hotmail.com.
authors.forename: Ágnes
authors.initials: Á
authors.lastname: Haris
authors.forename: Kálmán
authors.initials: K
authors.lastname: Polner
authors.forename: József
authors.initials: J
authors.lastname: Arányi
authors.forename: Henrik
authors.initials: H
authors.lastname: Braunitzer
authors.forename: Ilona
authors.initials: I
authors.lastname: Kaszás
authors.forename: István
authors.initials: I
authors.lastname: Mucsi
mesh_terms: D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D001379:Azathioprine / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000401:mortality*; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007239:Infections / Q000401:mortality*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D012709:Serum Albumin; D003520:Cyclophosphamide; D001379:Azathioprine; D008775:Methylprednisolone
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