PMID- 35497076
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220503
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 4
DP  - 2022 Apr
TI  - Disease Severity and Response to Induction Therapy in Hispanic Patients With 
      Antineutrophilic Cytoplasmic Autoantibody-Associated Vasculitis-Related Diffuse 
      Alveolar Hemorrhage.
PG  - e24470
LID - 10.7759/cureus.24470 [doi]
LID - e24470
AB  - Objectives We examined the response to induction therapy of Hispanic patients 
      with antibody-associated vasculitis (AAV)-related diffuse alveolar hemorrhage 
      (DAH). This study aimed to determine the severity of disease at presentation and 
      the response to induction therapy in our patient population. Methods We 
      retrospectively reviewed the clinical data of Hispanic patients hospitalized with 
      antineutrophil cytoplasmic antibody (ANCA) vasculitis between October 1, 2010, 
      and December 31, 2021. We identified 98 Hispanic patients hospitalized with AAV 
      and 19 admitted with AAV-related DAH. The Birmingham Vasculitis Activity Score 
      (BVAS) was obtained from all patients on presentation. Results Based on the 2012 
      Revised International Chapel Hill Consensus Conference Nomenclature of 
      Vasculitides, 12 patients met the diagnostic criteria for microscopic 
      polyangiitis (MPA) and seven met the criteria for diagnosing granulomatosis with 
      polyangiitis (GPA). All patients received methylprednisolone therapy. Induction 
      therapy consisted of cyclophosphamide pulse therapy (n=3), cyclophosphamide plus 
      plasmapheresis (PLEX) (n=1), rituximab induction therapy (n=8), and rituximab 
      induction plus plasmapheresis (n=6), and one patient received one dose of 
      cyclophosphamide followed by rituximab plus plasmapheresis. The average BVAS was 
      25.53 at presentation. Survival at six months included 67% (n=2) treated with 
      cyclophosphamide alone, 75% (n=6) treated with rituximab alone, and 50% (n=3) 
      treated with rituximab plus PLEX. The patient who received an initial loading 
      dose of cyclophosphamide followed by rituximab plus PLEX did survive for six 
      months; however, the patient treated with cyclophosphamide plus PLEX did not have 
      early survival. Conclusions Hispanic patients with ANCA-associated vasculitis 
      present with a more severe disease burden at presentation based on BVAS. 
      Approximately 37% of our patient population had early death (death at <6 months) 
      despite adhering to the standard of care for induction therapy. Due to the more 
      significant disease burden at presentation, it is vital to include ethnic 
      minorities in large clinical trials to help improve outcomes in these patient 
      populations.
CI  - Copyright (c) 2022, Loftis et al.
FAU - Loftis, Christine E
AU  - Loftis CE
AD  - Internal Medicine, University of Texas Rio Grande Valley School of Medicine, 
      Edinburg, USA.
AD  - Internal Medicine, Doctors Hospital at Renaissance, McAllen, USA.
FAU - Dulgheru, Emilia C
AU  - Dulgheru EC
AD  - Rheumatology, Doctors Hospital at Renaissance, McAllen, USA.
FAU - White, Rosa
AU  - White R
AD  - Internal Medicine, University of Texas Rio Grande Valley School of Medicine, 
      Edinburg, USA.
AD  - Internal Medicine, Doctors Hospital at Renaissance, McAllen, USA.
LA  - eng
PT  - Journal Article
DEP - 20220425
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9045553
OTO - NOTNLM
OT  - anca vasculitis
OT  - cyclophosphamide
OT  - diffuse alveolar hemorrhage
OT  - drug-induced vasculitis
OT  - granulomatosis with polyangiitis
OT  - hydralazine
OT  - microscopic polyangiitis
OT  - plasmapheresis
OT  - rituximab
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/05/03 06:00
MHDA- 2022/05/03 06:01
PMCR- 2022/04/25
CRDT- 2022/05/02 06:58
PHST- 2022/04/24 00:00 [accepted]
PHST- 2022/05/02 06:58 [entrez]
PHST- 2022/05/03 06:00 [pubmed]
PHST- 2022/05/03 06:01 [medline]
PHST- 2022/04/25 00:00 [pmc-release]
AID - 10.7759/cureus.24470 [doi]
PST - epublish
SO  - Cureus. 2022 Apr 25;14(4):e24470. doi: 10.7759/cureus.24470. eCollection 2022 
      Apr.