Makoto Yamaguchi1, Masahiko Ando1, Sawako Kato1, Takayuki Katsuno1, Noritoshi Kato1, Tomoki Kosugi1, Waichi Sato1, Naotake Tsuboi1, Yoshinari Yasuda1, Masashi Mizuno1, Yasuhiko Ito1, Seiichi Matsuo1, Shoichi Maruyama2. 1. From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine. 2. From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine. marus@med.nagoya-u.ac.jp.
Abstract
OBJECTIVE: The diagnostic values of antiproteinase 3 and antimyeloperoxidase tests using antineutrophil cytoplasmic antibodies (ANCA) are well established. Our study determined whether an increase in ANCA level was a predictor of disease flareup. METHODS: Our study included 126 patients with ANCA-associated renal vasculitis treated at 9 nephrology centers in Japan. The relationship between increased ANCA levels and relapse was assessed using time-dependent multivariate Cox regression models adjusted for clinically relevant factors. The outcome of interest was the time from remission to first relapse. RESULTS: During the observation period [median 41 mos, interquartile range (IQR) 23-66 mos], 118 patients (95.8%) achieved remission at least once. After achieving remission, 34 patients relapsed (21.7%). Time-dependent multivariate Cox regression models revealed that lung involvement (adjusted HR 2.29, 95% CI 1.13-4.65, p = 0.022) and increased ANCA levels (adjusted HR 17.4, 95% CI 8.42-36.0, p < 0.001) were significantly associated with relapse. The median time from ANCA level increase to relapse was 0.6 months (IQR 0-2.1 mos). CONCLUSION: In our study, an increase in ANCA level during remission was associated with a risk of disease relapse. A rise in ANCA level may be useful for guiding treatment decisions in appropriate subsets of patients with ANCA-associated vasculitis.
OBJECTIVE: The diagnostic values of antiproteinase 3 and antimyeloperoxidase tests using antineutrophil cytoplasmic antibodies (ANCA) are well established. Our study determined whether an increase in ANCA level was a predictor of disease flareup. METHODS: Our study included 126 patients with ANCA-associated renal vasculitis treated at 9 nephrology centers in Japan. The relationship between increased ANCA levels and relapse was assessed using time-dependent multivariate Cox regression models adjusted for clinically relevant factors. The outcome of interest was the time from remission to first relapse. RESULTS: During the observation period [median 41 mos, interquartile range (IQR) 23-66 mos], 118 patients (95.8%) achieved remission at least once. After achieving remission, 34 patients relapsed (21.7%). Time-dependent multivariate Cox regression models revealed that lung involvement (adjusted HR 2.29, 95% CI 1.13-4.65, p = 0.022) and increased ANCA levels (adjusted HR 17.4, 95% CI 8.42-36.0, p < 0.001) were significantly associated with relapse. The median time from ANCA level increase to relapse was 0.6 months (IQR 0-2.1 mos). CONCLUSION: In our study, an increase in ANCA level during remission was associated with a risk of disease relapse. A rise in ANCA level may be useful for guiding treatment decisions in appropriate subsets of patients with ANCA-associated vasculitis.
Entities:
Keywords:
ANCA LEVEL; ANCA-ASSOCIATED VASCULITIS; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; GRANULOMATOSIS WITH POLYANGIITIS; MICROSCOPIC POLYANGIITIS; RELAPSE
Authors: Michael J Kemna; Rosina Plomp; Pieter van Paassen; Carolien A M Koeleman; Bas C Jansen; Jan G M C Damoiseaux; Jan Willem Cohen Tervaert; Manfred Wuhrer Journal: EBioMedicine Date: 2017-01-28 Impact factor: 8.143
Authors: Kristen M Gibson; Renate Kain; Raashid A Luqmani; Colin J Ross; David A Cabral; Kelly L Brown Journal: Front Immunol Date: 2021-02-03 Impact factor: 7.561