Akinori Hara1,2, Takashi Wada3,4, Ken-Ei Sada1,2, Koichi Amano1,2, Hiroaki Dobashi1,2, Masayoshi Harigai1,2, Yoshinari Takasaki1,2, Hidehiro Yamada1,2, Hitoshi Hasegawa1,2, Taichi Hayashi1,2, Shouichi Fujimoto1,2, Eri Muso1,2, Tamihiro Kawakami1,2, Sakae Homma1,2, Masaharu Yoshida1,2, Junichi Hirahashi1,2, Noriyoshi Ogawa1,2, Satoshi Ito1,2, Hirofumi Makino1,2, Yoshihiro Arimura. 1. From the Department of Environmental and Preventive Medicine, and Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama; Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa; Division of Rheumatology and Allergology, Departments of Internal Medicine and Dermatology, St. Marianna University School of Medicine, Kawasaki; Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Matsuyama; Department of Rheumatology, Faculty of Medicine, University of Tsukuba, Tsukuba; Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki; Center for Nephrology and Urology, Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka; Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine, Hamamatsu; Division of Rheumatology, Niigata Rheumatic Center, Shibata; Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University; Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine; Department of Respiratory Medicine, Toho University Omori Medical Center; Division of Nephrology, Tokyo Medical University Hachioji Medical Center; Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo; Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan. 2. A. Hara, MD, PhD, Department of Environmental and Preventive Medicine, Kanazawa University; T. Wada, MD, PhD, Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University; K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; K. Amano, MD, PhD, Department of Rheumatology and Clinical Immunology, Saitama Medical Center; H. Dobashi, MD, PhD, Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University; Y. Takasaki, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine; H. Yamada, MD, PhD, Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine; H. Hasegawa, MD, PhD, Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine; T. Hayashi, MD, PhD, Department of Rheumatology, Faculty of Medicine, University of Tsukuba; S. Fujimoto, MD, PhD, Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki; E. Muso, MD, PhD, Center for Nephrology and Urology, Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute; T. Kawakami, MD, PhD, Department of Dermatology, St. Marianna University School of Medicine; S. Homma, MD, PhD, Department of Respiratory Medicine, Toho University Omori Medical Center; M. Yoshida, MD, PhD, Division of Nephrology, Tokyo Medical University, Hachioji Medical Center; J. Hirahashi, MD, PhD, Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo; N. Ogawa, MD, PhD, Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine; S. Ito, MD, PhD, Division of Rheumatology, Niigata Rheumatic Center; H. Makino, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Y. Arimura, MD, PhD, Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine. 3. From the Department of Environmental and Preventive Medicine, and Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama; Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa; Division of Rheumatology and Allergology, Departments of Internal Medicine and Dermatology, St. Marianna University School of Medicine, Kawasaki; Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Matsuyama; Department of Rheumatology, Faculty of Medicine, University of Tsukuba, Tsukuba; Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki; Center for Nephrology and Urology, Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka; Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine, Hamamatsu; Division of Rheumatology, Niigata Rheumatic Center, Shibata; Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University; Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine; Department of Respiratory Medicine, Toho University Omori Medical Center; Division of Nephrology, Tokyo Medical University Hachioji Medical Center; Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo; Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan. twada@m-kanazawa.jp. 4. A. Hara, MD, PhD, Department of Environmental and Preventive Medicine, Kanazawa University; T. Wada, MD, PhD, Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University; K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; K. Amano, MD, PhD, Department of Rheumatology and Clinical Immunology, Saitama Medical Center; H. Dobashi, MD, PhD, Division of Endocrinology and Metabolism, Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University; M. Harigai, MD, PhD, Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University; Y. Takasaki, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine; H. Yamada, MD, PhD, Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine; H. Hasegawa, MD, PhD, Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine; T. Hayashi, MD, PhD, Department of Rheumatology, Faculty of Medicine, University of Tsukuba; S. Fujimoto, MD, PhD, Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki; E. Muso, MD, PhD, Center for Nephrology and Urology, Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute; T. Kawakami, MD, PhD, Department of Dermatology, St. Marianna University School of Medicine; S. Homma, MD, PhD, Department of Respiratory Medicine, Toho University Omori Medical Center; M. Yoshida, MD, PhD, Division of Nephrology, Tokyo Medical University, Hachioji Medical Center; J. Hirahashi, MD, PhD, Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo; N. Ogawa, MD, PhD, Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine; S. Ito, MD, PhD, Division of Rheumatology, Niigata Rheumatic Center; H. Makino, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Y. Arimura, MD, PhD, Nephrology and Rheumatology, First Department of Internal Medicine, Kyorin University School of Medicine. twada@m-kanazawa.jp.
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.
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.