Prior to the introduction of effective treatment, patients with untreated systemic granulomatosis with polyangiitis (GPA) (formerly known as Wegener's granulomatosis) had a median survival of 5 months and most died within 12 months. Now, with aggressive immunosuppressive regimens, remission can be achieved in the large majority of patients. However, despite these advances, disease- and treatment-related morbidity and mortality remains a major problem.[69]Little MA, Nightingale P, Verburgh CA, et al; European Vasculitis Study (EUVAS) Group. Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis. Ann Rheum Dis. 2010 Jun;69(6):1036-43.
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[70]Mohammad AJ, Jacobsson LT, Westman KW, et al. Incidence and survival rates in Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Rheumatology (Oxford). 2009 Dec;48(12):1560-5.
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In one study, mortality was 13.6% at 1 year and increased with age.[7]Pearce FA, Grainge MJ, Lanyon PC, et al. The incidence, prevalence and mortality of granulomatosis with polyangiitis in the UK Clinical Practice Research Datalink. Rheumatology (Oxford). 2017 Apr 1;56(4):589-96.
https://www.doi.org/10.1093/rheumatology/kew413
http://www.ncbi.nlm.nih.gov/pubmed/28013209?tool=bestpractice.com
One third to one half of all patients will suffer at least one disease relapse.[9]Naidu GSRSNK, Misra DP, Rathi M, et al. Is granulomatosis with polyangiitis in Asia different from the West? Int J Rheum Dis. 2019 Jan;22(suppl 1):90-4.
http://www.ncbi.nlm.nih.gov/pubmed/30338654?tool=bestpractice.com
Furthermore, the vast majority of patients will develop at least one complication related to GPA and/or its treatment.[71]Seo P, Min YI, Holbrook JT, et al; WGET Research Group. Damage caused by Wegener's granulomatosis and its treatment: prospective data from the Wegener's Granulomatosis Etanercept Trial. Arthritis Rheum. 2005 Jul;52(7):2168-78.
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Data from a large multicentre cohort study suggest that the main causes of mortality are infection, cardiovascular disease, and active vasculitis.[72]Flossmann O, Berden A, de Groot K, et al; European Vasculitis Study Group. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011 Mar;70(3):488-94.
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