An earlier Chinese study suggested that the risk of disease relapse and resistance to a patient’s initial therapy was increased in the presence of issues in the lungs. Symptoms of early lung involvement may include fatigue, shortness of breath and coughing.
Elevated creatinine levels may also be responsible for treatment resistance.
On the other hand, higher levels of globulins (protein), C3 protein, and platelets lowered the risk of resistance to treatment.
The study was prompted by previous inconclusive and conflicting results from trials that investigated the risk factors faced by AAV patients in remission. The Clinical and Experimental Medicine journal published the study in February 2020.
Researchers question whether predictions for relapse and resistance of the diseases in Caucasians would apply to Chinese patients with MPO autoantibodies. The most common AAV type in China is MPA (microscopic polyangiitis). But most of the studies involved Caucasians involved different AAV types versus Asian populations.
About The Study
A team of researchers at a Chinese medical center conducted a study of 184 patients (84 women and 100 men) with MPO-AAV. Their goal was to determine risk factors.
The patients had been diagnosed with the disease between January 2009 and January 2018. The types of AAV varied, but ninety-one percent were classified as MPA. The median age was fifty-eight. Patients were observed for a median period of seventeen months ranging from one month to ten years.
The researchers found that the following organs were affected:
- Kidneys – 95.1%
- Lungs – 59.2%
- Nervous system – 23.4%
- Cardiovascular system – 16.3%
Results of the test found that sixty-four patients, or thirty-four percent, showed resistance to the induction (initial) therapy. These numbers confirmed that lung issues as well as elevated levels of creatinine (affecting kidneys) were present.
The researchers noted that since the high levels of creatinine predict resistance to treatment, it is imperative that immunosuppressive therapy begins immediately.
One hundred twenty patients achieved remission after induction therapy. However, twenty-nine patients relapsed. The cause was associated with lung and cardiovascular issues.
The study also confirmed that the participants had lower rates of remission when compared to Americans and Europeans. All subjects tested positive for MPO autoantibodies.
Another critical observation of patients who had relapsed or were resistant to treatment was that these patients had a higher risk of progressing to end-stage renal disease.
In the final analysis, the study indicates that lung issues and elevated creatinine are both risk factors for resistance to treatment. Cardiovascular or lung issues are found to increase disease relapse.
The researchers caution that their findings need additional confirmation but believe that as presented the study may have identified patients with high-risk disease and may improve disease management.