Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan

A nationwide, prospective cohort study

Research Committee on Intractable Vasculitides, Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective. The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods. Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections. Results. The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95% (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24% (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95% CI 1.1-8.5). Conclusion. One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.

Original languageEnglish
Pages (from-to)521-528
Number of pages8
JournalJournal of Rheumatology
Volume45
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Antineutrophil Cytoplasmic Antibodies
Vasculitis
Japan
Cohort Studies
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Prospective Studies
Remission Induction
Recurrence
Prednisolone
Kidney
Therapeutics
Outcome Assessment (Health Care)
Infection
Thyroid Neoplasms
Cause of Death
Survival Rate
Safety
Incidence

Keywords

  • Antineutrophil cytoplasmic antibody
  • Immunosuppressive agents
  • Remission-maintenance therapy
  • Risk factors corticosteroid

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Research Committee on Intractable Vasculitides, & Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline (2018). Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan: A nationwide, prospective cohort study. Journal of Rheumatology, 45(4), 521-528. https://doi.org/10.3899/jrheum.170508

Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan : A nationwide, prospective cohort study. / Research Committee on Intractable Vasculitides; Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline.

In: Journal of Rheumatology, Vol. 45, No. 4, 01.04.2018, p. 521-528.

Research output: Contribution to journalArticle

Research Committee on Intractable Vasculitides & Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline 2018, 'Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan: A nationwide, prospective cohort study', Journal of Rheumatology, vol. 45, no. 4, pp. 521-528. https://doi.org/10.3899/jrheum.170508
Research Committee on Intractable Vasculitides, Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline. Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan: A nationwide, prospective cohort study. Journal of Rheumatology. 2018 Apr 1;45(4):521-528. https://doi.org/10.3899/jrheum.170508
Research Committee on Intractable Vasculitides ; Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline. / Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan : A nationwide, prospective cohort study. In: Journal of Rheumatology. 2018 ; Vol. 45, No. 4. pp. 521-528.
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abstract = "Objective. The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods. Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections. Results. The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95{\%} (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24{\%} (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95{\%} CI 1.1-8.5). Conclusion. One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.",
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T1 - Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis in Japan

T2 - A nationwide, prospective cohort study

AU - Research Committee on Intractable Vasculitides

AU - Strategic Study Group to Establish the Evidence for Intractable Vasculitis Guideline

AU - Hara, Akinori

AU - Wada, Takashi

AU - Sada, Kenei

AU - Amano, Koichi

AU - Dobashi, Hiroaki

AU - Harigai, Masayoshi

AU - Takasaki, Yoshinari

AU - Yamada, Hidehiro

AU - Hasegawa, Hitoshi

AU - Hayashi, Taichi

AU - Fujimoto, Shouichi

AU - Muso, Eri

AU - Kawakami, Tamihiro

AU - Homma, Sakae

AU - Yoshida, Masaharu

AU - Hirahashi, Junichi

AU - Ogawa, Noriyoshi

AU - Ito, Satoshi

AU - Makino, Hirofumi

AU - Arimura, Yoshihiro

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objective. The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods. Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections. Results. The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95% (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24% (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95% CI 1.1-8.5). Conclusion. One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.

AB - Objective. The aim was to elucidate the prognosis and risk factors associated with relapse during longterm remission maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods. Patients with newly diagnosed AAV (n = 156) were registered in the Remission Induction Therapy in Japanese patients with ANCA-associated Vasculitides (RemIT-JAV) study, and among them, 83 patients who achieved remission were enrolled and followed up for 24 additional months in our nationwide, prospective cohort study (Co-RemIT-JAV; registration number UMIN 000006373). Patterns of maintenance therapy, effectiveness, and safety were evaluated from months 25 to 48 after the RemIT-JAV. The primary outcome measure was the rate of relapse. Secondary outcome measures included overall and renal survival, risk factors associated with relapse, and incidence rates of serious infections. Results. The patients comprised 35 men and 48 women aged 65.3 ± 12.6 years. Between months 25 and 48, the survival rate was 95% (79/83). Causes of death included 1 thyroid cancer, 1 infection, and 2 unknown reasons. Four patients had developed endstage renal disease (ESRD) by Month 24; 1 developed ESRD beyond Month 25. The relapse rate was 24% (20/83) from months 25 to 48. Multivariable analysis revealed that oral prednisolone ≤ 2.5 mg/day at Month 24 was a significant risk factor for relapse between months 25 and 48 (HR = 3.1, 95% CI 1.1-8.5). Conclusion. One-quarter of patients with AAV relapsed during maintenance therapy, and relapse was associated with the dose of oral prednisolone 24 months after the initiation of remission induction therapy in Japan.

KW - Antineutrophil cytoplasmic antibody

KW - Immunosuppressive agents

KW - Remission-maintenance therapy

KW - Risk factors corticosteroid

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