Because the disease is rarer in children, pediatricians who treat these young patients with AAV may go months or longer before encountering another case. “Some places may see one of these kids every few years,” says Dr. James.
That often means a physician with experience treating a child with one effective medicine may prove reluctant to transition to a new one (e.g., rituximab) when treating the next child. Studying AAV regimens used for pediatric patients across the nation brings an understanding to actual practices and how they vary, says Dr. James, noting that different ways exist to treat diseases.
The Study
In this study, researchers reviewed data from 2004–2014 involving pediatric patients hospitalized with AAV. Using an administrative and billing database from 47 tertiary care pediatric hospitals throughout the country, the researchers examined factors surrounding the initial hospitalization and initial treatments for children later discharged with a diagnosis code of AAV.
Of 523 pediatric patients screened, 393 met the study criteria, which targeted newly diagnosed patients with active disease and those with a new relapse of disease. The average age of study participants was approximately 14 years old, and slightly more girls (61%) than boys were included. The average time in the hospital was nine days for first admissions, and about twice that for patients needing dialysis and/or mechanical ventilation.
“These are patients who haven’t been admitted in six months,” Dr. James says about those included in her study. “Either they are [newly diagnosed], or they’re [experiencing disease] flares.”
Doctors generally give induction treatments to both newly diagnosed patients and those who experience a flare. Thus, the study targeted patients who had received similar therapy.
“You get … an induction treatment,” says Dr. James, explaining typical therapy for pediatric patients in the study. “Things are quiet. You get on a maintenance medication. Maybe you are still on the maintenance or maybe you’ve come off it, and you have a flare of disease and you go back to induction.”
Researchers tracked how many patients received cyclophosphamide and rituximab and whether use of the drugs increased or decreased over the years. It also considered other treatment factors, such as the need for dialysis and mechanical ventilation, and use of plasma exchange, an additional option often used for the sickest patients.
“There was an increasing trend in the use of rituximab over time during the study period (P<0.05) and a decreasing trend in the use of cyclophosphamide (P<0.05),” the article states. “Treatment use varied significantly between hospitals, especially for plasma exchange.”
