Abstract
Objective. Fatigue is common and burdensome in antineutrophil cytoplasmic antibody–associated vasculitis (AAV). This study aimed to understand how fatigue changes over time following treatment initiation and to determine whether individuals with the poorest prognosis can be robustly identified.
Methods. One hundred forty-nine patients with AAV and new-onset disease recruited to 2 clinical trials (RITUXVAS and MYCYC) were followed for 18 months. Fatigue was measured at baseline and 6-month intervals using the vitality domain of the Medical Outcomes Study Short Form-36 quality of life questionnaire and compared to a cohort of 470 controls. Group-based trajectory modeling (GBTM) determined trajectories of the symptom to which baseline characteristics and ongoing fatigue scores were compared.
Results. Fatigue levels at diagnosis were worse in patients than controls [median (interquartile range; IQR) 30 (10–48) vs 70 (55–80); p < 0.001], with 46% of patients reporting severe fatigue. Fatigue improved after 6 months of treatment but remained worse than in controls (p < 0.001). GBTM revealed varied trajectories of fatigue: low fatigue stable (n = 23), moderate baseline fatigue improvers (n = 29), high baseline fatigue improvers (n = 61), and stable baseline high fatigue (n = 37). Participants who followed stable high fatigue trajectories had lower vasculitis activity compared to improvers, but no other demographic or clinical variables differed.
Conclusion. This study longitudinally measured fatigue levels in patients with AAV. Although most patients improved following treatment, an important subgroup of patients reported persistently high levels of fatigue that did not change. Few clinical or laboratory markers distinguished these patients, suggesting alternative interventions specific for fatigue are required. [clinicaltrialsregister.eu, RITUXVAS EudraCT number: 2005-003610-15; MYCYC EudraCT number: 2006-001663-33]
Footnotes
This work was supported by Vifor Pharma (previously Aspreva Pharmaceuticals), which provided a research grant to cover the trial and mycophenolate mofetil costs for MYCYC and F. Hoffmann–La Roche, which provided the rituximab and a research grant that contributed to trial costs for RITUXVAS. The funding sources had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data, preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. The study was conducted within the Birmingham National Institute for Health Research (NIHR)/Wellcome Trust Clinical Research Facility (Birmingham, UK). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the Department of Health.
- Accepted for publication June 20, 2019.
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