Practice patterns of ANCA-associated vasculitis: exploring differences among subspecialties at a single academic medical centre.
OBJECTIVE
Clinical trial data help guide physician treatment choices for ANCA-associated vasculitis (AAV), but when data are lacking, treatment choices are largely driven by physician preference. Our aim was to examine AAV treatment preferences to determine if patient gender and age, and physician subspecialty affect treatment choices.


METHODS
Rheumatologists, nephrologists and pulmonologists from an academic medical centre participated in a web-based survey. Three scenarios (remission induction in severe disease; remission maintenance in severe disease; remission induction in limited disease) were presented for 4 patient profiles (28- and 68-year-old female/male). Physician treatment choices and reasons for these choices were obtained. Differences between groups were analysed using Chi-Square and Fisher's exact tests.


RESULTS
Physicians were significantly more likely to choose rituximab for young females for remission induction in severe AAV, with toxicity being the main reason for this choice. There was a trend toward rheumatologists choosing rituximab over cyclophosphamide compared with other subspecialties for this scenario. Most physicians switched to a less toxic agent for remission maintenance, but there was little agreement as to choice of maintenance therapy among subspecialties. For remission induction in limited disease, most physicians chose rituximab, particularly for young females.


CONCLUSIONS
Currently, there are very few data for remission maintenance therapy following rituximab in severe disease, as well as the use of rituximab in limited disease. Choices for treatment of AAV differ among subspecialties, are affected by patient gender and age, and tend to be largely driven by physician preference when data are limited or lacking.
Department of Rheumatology, Hospital for Special Surgery, New York, USA. lindsy.forbess@cshs.org.
Lindsy J
LJ
Forbess
Kenneth W
KW
Griffin
Robert F
RF
Spiera
D000328:Adult; D000367:Age Factors; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy* / Q000276:immunology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D062072:Patient Acuity; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012074:Remission Induction; D012307:Risk Factors; D000069283:Rituximab; D055502:Secondary Prevention; D012737:Sex Factors; D014481:United States
D019268:Antibodies, Antineutrophil Cytoplasmic; D058846:Antibodies, Monoclonal, Murine-Derived; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide