RT Journal Article
SR Electronic
T1 Risk Factors for Relapse of Antineutrophil Cytoplasmic Antibody-associated Vasculitis in Japan: A Nationwide, Prospective Cohort Study
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 521
OP 528
DO 10.3899/jrheum.170508
VO 45
IS 4
A1 Akinori Hara
A1 Takashi Wada
A1 Ken-ei Sada
A1 Koichi Amano
A1 Hiroaki Dobashi
A1 Masayoshi Harigai
A1 Yoshinari Takasaki
A1 Hidehiro Yamada
A1 Hitoshi Hasegawa
A1 Taichi Hayashi
A1 Shouichi Fujimoto
A1 Eri Muso
A1 Tamihiro Kawakami
A1 Sakae Homma
A1 Masaharu Yoshida
A1 Junichi Hirahashi
A1 Noriyoshi Ogawa
A1 Satoshi Ito
A1 Hirofumi Makino
A1 Yoshihiro Arimura
YR 2018
UL http://www.jrheum.org/content/45/4/521.abstract
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.