Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit
Objectives: We aimed to conduct a large audit of routine care for patients with ANCA-associated vasculitis (AAV). Methods: We invited all 34 hospitals within one health region in England to undertake a retrospective case note audit of all patients newly-diagnosed or treated with Cyclophosphamide...
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| Format: | Article |
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Oxford University Press
2018
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| Online Access: | https://eprints.nottingham.ac.uk/52824/ |
| _version_ | 1848798818443722752 |
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| author | Pearce, Fiona McGrath, Catherine Sandhu, Ravinder Packham, Jon C. Watts, Richard Rhodes, Benjamim Reem, Al-Jayyousi Harper, Lorraine Obrenovic, Karen Lanyon, Peter C. |
| author_facet | Pearce, Fiona McGrath, Catherine Sandhu, Ravinder Packham, Jon C. Watts, Richard Rhodes, Benjamim Reem, Al-Jayyousi Harper, Lorraine Obrenovic, Karen Lanyon, Peter C. |
| author_sort | Pearce, Fiona |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objectives: We aimed to conduct a large audit of routine care for patients with ANCA-associated vasculitis (AAV).
Methods: We invited all 34 hospitals within one health region in England to undertake a retrospective case note audit of all patients newly-diagnosed or treated with Cyclophosphamide or Rituximab for AAV April 2013-December 2014. We compared clinical practice to the BSR guideline for the management of adults with AAV, and use of Rituximab to the NHS England commissioning policy and NICE Technology Appraisal.
Results: We received data from 213 patients. Among 130 newly diagnosed patients, delay from admission to diagnosis ranged from 0-53 days (median 6, IQR 3-10.5) for those diagnosed as in-patients. BVAS score was recorded in 8% at diagnosis. Remission at 6 months was achieved in 83% of patients. 1-year survival was 91.5%. 130 patients received Cyclophosphamide for new-diagnosis or relapse. The correct dose of i.v. cyclophosphamide (within 100mg of the target dose calculated for age, weight and creatinine) was administered in 58%. 25% of patients had an infection requiring hospital admission during or within 6 months of completing their cyclophosphamide therapy. 76 patients received Rituximab for new-diagnosis or relapse. 97% patients met NHS England or NICE eligibility criteria. PJP prophylaxis (recommended in the summary of product characteristics) was given in only 65% of patients.
Conclusion: We identified opportunities to improve care, including compliance with safety standards for delivery of cyclophosphamide. Development of a national treatment protocol / checklist to reduce this heterogeneity in care should be considered as a priority. |
| first_indexed | 2025-11-14T20:25:49Z |
| format | Article |
| id | nottingham-52824 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T20:25:49Z |
| publishDate | 2018 |
| publisher | Oxford University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-528242020-05-04T19:45:14Z https://eprints.nottingham.ac.uk/52824/ Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit Pearce, Fiona McGrath, Catherine Sandhu, Ravinder Packham, Jon C. Watts, Richard Rhodes, Benjamim Reem, Al-Jayyousi Harper, Lorraine Obrenovic, Karen Lanyon, Peter C. Objectives: We aimed to conduct a large audit of routine care for patients with ANCA-associated vasculitis (AAV). Methods: We invited all 34 hospitals within one health region in England to undertake a retrospective case note audit of all patients newly-diagnosed or treated with Cyclophosphamide or Rituximab for AAV April 2013-December 2014. We compared clinical practice to the BSR guideline for the management of adults with AAV, and use of Rituximab to the NHS England commissioning policy and NICE Technology Appraisal. Results: We received data from 213 patients. Among 130 newly diagnosed patients, delay from admission to diagnosis ranged from 0-53 days (median 6, IQR 3-10.5) for those diagnosed as in-patients. BVAS score was recorded in 8% at diagnosis. Remission at 6 months was achieved in 83% of patients. 1-year survival was 91.5%. 130 patients received Cyclophosphamide for new-diagnosis or relapse. The correct dose of i.v. cyclophosphamide (within 100mg of the target dose calculated for age, weight and creatinine) was administered in 58%. 25% of patients had an infection requiring hospital admission during or within 6 months of completing their cyclophosphamide therapy. 76 patients received Rituximab for new-diagnosis or relapse. 97% patients met NHS England or NICE eligibility criteria. PJP prophylaxis (recommended in the summary of product characteristics) was given in only 65% of patients. Conclusion: We identified opportunities to improve care, including compliance with safety standards for delivery of cyclophosphamide. Development of a national treatment protocol / checklist to reduce this heterogeneity in care should be considered as a priority. Oxford University Press 2018-07-31 Article PeerReviewed Pearce, Fiona, McGrath, Catherine, Sandhu, Ravinder, Packham, Jon C., Watts, Richard, Rhodes, Benjamim, Reem, Al-Jayyousi, Harper, Lorraine, Obrenovic, Karen and Lanyon, Peter C. (2018) Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit. Rheumatology Advances in Practice . ISSN 2514-1775 ANCA-associated vasculitis; Audit; Routine care; Cyclophosphamide; Survival https://academic.oup.com/rheumap/advance-article/doi/10.1093/rap/rky025/5062624 doi:10.1093/rap/rky025 doi:10.1093/rap/rky025 |
| spellingShingle | ANCA-associated vasculitis; Audit; Routine care; Cyclophosphamide; Survival Pearce, Fiona McGrath, Catherine Sandhu, Ravinder Packham, Jon C. Watts, Richard Rhodes, Benjamim Reem, Al-Jayyousi Harper, Lorraine Obrenovic, Karen Lanyon, Peter C. Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title | Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title_full | Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title_fullStr | Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title_full_unstemmed | Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title_short | Outcomes and compliance with standards of care in ANCA-associated vasculitis: insights from a large multi-region audit |
| title_sort | outcomes and compliance with standards of care in anca-associated vasculitis: insights from a large multi-region audit |
| topic | ANCA-associated vasculitis; Audit; Routine care; Cyclophosphamide; Survival |
| url | https://eprints.nottingham.ac.uk/52824/ https://eprints.nottingham.ac.uk/52824/ https://eprints.nottingham.ac.uk/52824/ |