ANCA-Associated Vasculitis Management in the United States: Data from the Rheumatology Informatics System for Effectiveness (RISE) Registry.

Objective ANCA-associated vasculitis (AAV) management has evolved substantially over the last two decades. We sought to characterize AAV treatment patterns in the United States. Methods We identified AAV patients in the Rheumatology Informatics System for Effectiveness (RISE) registry who had at least two rheumatology clinician visits between January 1st, 2015 and December 31st, 2017. Demographics, medications, laboratory test results, and billing codes were extracted from the medical record. Demographic and prescription trends were assessed overall and across US regions. Results We identified 1,462 AAV patients, 259 (18%) with new or relapsing AAV. The majority were classified as having granulomatosis with polyangiitis (GPA, 75%). The mean age was 59.8 years and 59% were female. The majority of patients were in the South (45%) followed by the Mid-West (32%), West (12%), and Northeast (8%). Patients had a median of 3 visits and follow-up of 579 days. The most commonly prescribed medications during the study period were glucocorticoids (86%) followed by rituximab (45%), methotrexate (33%), azathioprine (32%) and mycophenolate mofetil (18%); cyclophosphamide was rarely used (97, 7%). At the most recent visits in RISE, 47% of patients were on glucocorticoids. Prescription trends were similar across regions. Conclusion This is the first study to evaluate the demographics and management of AAV by rheumatologists outside of major referral centers. Management strategies vary widely but cyclophosphamide is rarely used. These observations can be used to inform future research priorities. Additional studies are needed to characterize AAV severity in RISE and patient and provider treatment preferences.