Do adult disease severity subclassifications predict use of cyclophosphamide in children with ANCA-associated vasculitis? An analysis of ARChiVe study treatment decisions.
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Morishita Kimberly, Guzman Jaime, Chira Peter, Muscal Eyal, Zeft Andrew, Klein-Gitelman Marisa, Uribe America G, Abramson Leslie, Benseler Susanne M, Eberhard Anne, Ede Kaleo, Hashkes Philip J, Hersh Aimee O, Higgins Gloria, Imundo Lisa F, Jung Lawrence, Kim Susan, Kingsbury Daniel J, Lawson Erica F, Lee Tzielan, Li Suzanne C, Lovell Daniel J, Mason Thomas, McCurdy Deborah, O'Neil Kathleen M, Punaro Marilynn, Ramsey Suzanne E, Reiff Andreas, Rosenkranz Margalit, Schikler Kenneth N, Scuccimarri Rosie, Singer Nora G, Stevens Anne M, van Mater Heather, Wahezi Dawn M, White Andrew J, Cabral David A, ARChiVe Investigators Network
Аннотация
METHODS: We applied the European Vasculitis Study (EUVAS) and Wegener's Granulomatosis Etanercept Trial (WGET) disease severity subclassification systems to pediatric patients with AAV in A Registry for Childhood Vasculitis (ARChiVe). Modifications were made to the EUVAS and WGET systems to enable their application to this cohort of children. Treatment was categorized into 2 groups, "cyclophosphamide" and "no cyclophosphamide." Pearson's chi-square and Kendall's rank correlation coefficient statistical analyses were used to determine the relationship between disease severity subgroup and treatment at the time of diagnosis.
RESULTS: In total, 125 children with AAV were studied. Severity subgroup was associated with treatment group in both the EUVAS (chi-square 45.14, p < 0.001, Kendall's tau-b 0.601, p < 0.001) and WGET (chi-square 59.33, p < 0.001, Kendall's tau-b 0.689, p < 0.001) systems; however, 7 children classified by both systems as having less severe disease received CYC, and 6 children classified as having severe disease by both systems did not receive CYC.
CONCLUSION: In this pediatric AAV cohort, the EUVAS and WGET adult severity subclassification systems had strong correlation with physician choice of treatment. However, a proportion of patients received treatment that was not concordant with their assigned severity subclass.