<b>Background:</b> The benefits of treating anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) in advancing age remains unclear with most published studies defining elderly as ≥65 years. This study aims to determine outcomes of induction immunosuppression in patients aged ≥75 years. <b>Methods:</b> A cohort of patients aged ≥75 years with a diagnosis of AAV between 2006 and 2018 was constructed from 2 centres. Follow-up was to 2 years or death. Analysis included multivariable Cox regression to compare mortality and end-stage renal disease (ESRD) based on receipt of induction immunosuppression therapy with either cyclophosphamide or rituximab. A systematic review of outcome studies was subsequently undertaken amongst this patient group through Pubmed, Cochrane and Embase databases from inception until October 16, 2019. <b>Results:</b> Sixty-seven patients were identified. Mean age was 79 ± 2.9 years and 82% (<i>n</i> = 55) received induction immunosuppression. Following systematic review, 4 studies were eligible for inclusion, yielding a combined total of 290 patients inclusive of our cohort. The aggregated 1-year mortality irrespective of treatment was 31% (95% CI 25–36%). Within our cohort, induction immunosuppression therapy was associated with a significantly lower 2-year mortality risk (hazard ratio [HR] 0.29 [95% CI 0.09–0.93]). The pooled HR by meta-analysis confirmed this with a significant risk reduction for death (HR 0.31 [95% CI 0.16–0.57], <i>I</i>² = 0%). Treated patients had a lower pooled rate of ESRD, but was not statistically significant (HR 0.71 [95% CI 0.15–3.35]). <b>Conclusion:</b> This meta-analysis suggests that patients ≥75 years with AAV do benefit from induction immunosuppression with a significant survival benefit. Age alone should not be a limiting factor when considering treatment.

中文翻译：

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ANCA 血管炎：患者的治疗选择和期望

<b>背景：</b> 治疗抗中性粒细胞胞质自身抗体相关血管炎 (AAV) 在高龄中的益处仍不清楚，大多数已发表的研究将老年人定义为≥65 岁。本研究旨在确定 75 岁以上患者诱导免疫抑制的结果。<b>方法：</b> 从 2 个中心构建了 2006 年至 2018 年间诊断为 AAV 的年龄≥75 岁的患者队列。随访至 2 年或死亡。分析包括多变量 Cox 回归，以根据接受环磷酰胺或利妥昔单抗诱导免疫抑制治疗比较死亡率和终末期肾病 (ESRD)。随后通过 Pubmed 在该患者组中对结果研究进行了系统评价，Cochrane 和 Embase 数据库从开始到 2019 年 10 月 16 日。<b>结果：</b>确定了 67 名患者。平均年龄为 79 ± 2.9 岁，82% (<i>n</i> = 55) 接受了诱导免疫抑制。经过系统审查，有 4 项研究符合纳入标准，总共有 290 名患者（包括我们的队列）。不考虑治疗的 1 年总死亡率为 31% (95% CI 25–36%)。在我们的队列中，诱导免疫抑制治疗与显着降低的 2 年死亡风险相关（风险比 [HR] 0.29 [95% CI 0.09–0.93]）。通过荟萃分析汇总的 HR 证实了这一点，死亡风险显着降低（HR 0.31 [95% CI 0.16–0.57]，<i>I</i>² = 0%）。接受治疗的患者的 ESRD 合并率较低，但没有统计学意义（HR 0.71 [95% CI 0.15–3.35]）。<b>结论：</b>这项荟萃分析表明，≥75 岁的 AAV 患者确实受益于诱导免疫抑制，并具有显着的生存获益。考虑治疗时，年龄本身不应成为限制因素。