Estimating 2-year risk of first relapse in ANCA-associated vasculitis: derivation of a risk-prediction model based on participants in the PEXIVAS trial.
Mats Junek, Quazi Ibrahim, Peter A Merkel et al.
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In 30 seconds
This post hoc analysis derived a model to estimate first-relapse risk within 2 years of remission among participants with ANCA-associated vasculitis (AAV) enrolled in the PEXIVAS trial who had eGFR <50 mL/min/1.73 m² or diffuse alveolar haemorrhage and achieved remission. Among 649 participants, 100 relapsed within 2 years. The model incorporated sex, induction agent, ANCA subtype, selected organ involvement at presentation, and eGFR at remission. Its optimism-corrected Harrell’s area under the receiver-operator curve was 0.709 (95% CI 0.707-0.710), with a calibration slope of 0.99 (95% CI 0.65-1.34).
Key findings
- Of 649 participants who achieved remission, 100 experienced a first relapse within 2 years.
- The model included sex, induction agent, ANCA subtype, nonhaemorrhagic respiratory or mucous membrane/eye involvement at presentation, and eGFR at remission.
- Discrimination was 0.709 (95% CI 0.707-0.710); the calibration slope was 0.99 (95% CI 0.65-1.34).
Why it matters
Relapse risk varies among people with AAV, and a structured estimate could help frame decisions about follow-up and treatment after remission. This model combines clinical features and remission kidney function, but its performance in the trial population does not establish how well it will work in other settings.
What to keep in mind
The analysis was post hoc and restricted to PEXIVAS participants with eGFR <50 mL/min/1.73 m² or diffuse alveolar haemorrhage who achieved remission. The authors state that external validation is needed.