Long-term outcomes of the WEGENT trial on remission-maintenance for granulomatosis with polyangiitis or microscopic polyangiitis

Xavier Puéchal 1, * Christian Pagnoux 2 Elodie Perrodeau 3 Mohamed Hamidou 4 Jean-Jacques Boffa 5, 6 Xavier Kyndt 7 François Lifermann 8 Thomas Papo 9 Dominique Merrien 10 Amar Smail 11 Philippe Delaval 12, 13 Catherine Hanrotel-Saliou 14, 15 Bernard Imbert 16 Chahéra Khouatra 17 Marc Lambert 18 Charles Leské 19 Kim Ly 20 Edouard Pertuiset 21 Pascal Roblot 22 Marc Ruivard 23 Jean-François Subra 24 Jean-François Viallard 25 Benjamin Terrier 2, 1 Pascal Cohen 26 Luc Mouthon 27, 26 Claire Le Jeunne 1 Philippe Ravaud 3 Loïc Guillevin 2
Abstract : OBJECTIVE: The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. METHODS: Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. RESULTS: Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm differences were observed for relapse, adverse events, damage, survival rates without severe side effects and survival rates without relapse and severe side effects. Considering only the 97 GPA patients, no between-arm survival differences were observed. Relapse-free survival was shorter for GPA than MPA patients but the multivariate analysis retained anti-PR3-ANCA-positivity, and not GPA, as being independently associated with relapse. CONCLUSION: This long-term analysis confirms that azathioprine and methotrexate are comparable options for maintaining GPA or MPA remission. Despite good overall survival, relapses, adverse events and damage remain matters of concern and further studies are needed to reduce them.
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Arthritis & rheumatology, Wiley, 2016, 68 (3), pp.690-701. <10.1002/art.39450>
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Xavier Puéchal, Christian Pagnoux, Elodie Perrodeau, Mohamed Hamidou, Jean-Jacques Boffa, et al.. Long-term outcomes of the WEGENT trial on remission-maintenance for granulomatosis with polyangiitis or microscopic polyangiitis. Arthritis & rheumatology, Wiley, 2016, 68 (3), pp.690-701. <10.1002/art.39450>. <hal-01217989>

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