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Autoimmun Rev. 2014 Jun;13(6):630-4. doi: 10.1016/j.autrev.2013.11.006. Epub 2014 Jan 10.

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

Author information

  • 1Department of Internal Medicine, National Reference Center for Autoimmune Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), Université Pierre Descartes, Paris 5, Paris, France.
  • 2Department of Internal Medicine, CHU, Rouen, France.
  • 3Department of Internal Medicine, CHRU Claude Huriez, Lille, France.
  • 4Department of Nephrology, CH Côte Basque, Bayonne, France.
  • 5Department of Internal Medicine, CHU, Marseille, France.
  • 6Department of Internal Medicine, CHU, Brest, France.
  • 7Department of Internal Medicine, CH, Valenciennes, France.
  • 8Department of Nephrology, CHU, Toulouse, France.
  • 9Department of Internal Medicine, CHU, Bordeaux, France.
  • 10Department of Internal Medicine, CHU, Clermont-Ferrand, France.
  • 11Department of Internal Medicine, Hôpital Foch, Suresnes, France.
  • 12Department of Internal Medicine, CH, Mulhouse, France.
  • 13Department of Internal Medicine, CHU, Montpellier, France.
  • 14Department of Internal Medicine, CHU, Tours, France.
  • 15Department of Nephrology, CHU, Poitiers, France.
  • 16Department of Internal Medicine, CH, Valence, France.
  • 17UMR-S707, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris 6, Paris, France.
  • 18Department of Hematology, Hôpital Necker-Enfants Malades, Paris, France.
  • 19Department of Neurology, Groupe Hospitalier Pitié-Salpetrière, Paris, France.
  • 20Department of Rheumatology, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, Université Paris-Sud, France.
  • 21Department of Dermatology, Hôpital Tenon, Paris, France.
  • 22Nephrology, Hôpital Tenon, Paris, France.
  • 23Department of Internal Medicine, Reference Center for Autoimmune Diseases, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris 6, UMR 7211, F-75005 Paris, France; INSERM, UMR S 959, F-75013 Paris, France; CNRS, UMR 7211, F-75005 Paris, France; Departement Hospitalo-Universitaire I2B, Univ Paris 06, UMR 7211, F-75005, Paris, France; AP-HP, Groupe Hoitalier Pitié-Salpérière, Departement of Internal Médicine, 75013, Paris, France. Electronic address: patrice.cacoub@gmail.com.

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.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS:

Mixed cryoglobulinemia; Relapse; Vasculitis

PMID:
24418300
[PubMed - indexed for MEDLINE]
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