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Box 9 Elderly subjects

From: French recommendations for the management of systemic necrotizing vasculitides (polyarteritis nodosa and ANCA-associated vasculitides)

There is no existing age limit that has been agreed upon, to define the “elderly” population. As regards vasculitis, an age upwards of 65, however, very often defines “elderly subjects”

In regard to induction treatment for vasculitis, no data in the literature allow us to favor rituximab over cyclophosphamide in this population. Nevertheless, whatever the treatment that may be chosen, the risk of infection is higher among subjects older than 65 years of age who are receiving high doses of corticosteroid therapy and a conventional immunosuppressant. Thus, rituximab or cyclophosphamide may be prescribed as induction treatment for remission after 65 years of age

Regimen for administering cyclophosphamide

Among elderly patients older than 65, whatever their renal function, the regimen recommended is as follows: cyclophosphamide given by intravenous bolus, prescribed at a dose of 0.5 g as a fixed dose on days 1, 15, and 29; then every 21 days (for a total of six boluses). The value of this regimen has been demonstrated in the CORTAGE prospective trial, which showed an effectiveness comparable to conventional treatment, but with improved tolerance

Regimen for administering rituximab (RTX)

Among elderly patients older than 65, the recommended regimen is the same as for patients who are younger than 65

RTX has not been specifically evaluated in prospective studies in this population, but retrospective studies show good tolerance