Optimal dose of intravenous cyclophosphamide during remission induction therapy in ANCA-associated vasculitis: A retrospective cohort study of J-CANVAS.

Autor:	Sofue H; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Kida T; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Hirano A; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Omura S; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Kadoya M; Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan., Nakagomi D; Department of Rheumatology, University of Yamanashi Hospital, Yamanashi, Japan., Abe Y; Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, Japan., Takizawa N; Department of Rheumatology, Chubu Rosai Hospital, Nagoya, Japan., Nomura A; Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan., Kukida Y; Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan., Kondo N; Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan., Yamano Y; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan., Yanagida T; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.; Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan., Endo K; Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Japan., Hirata S; Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan., Matsui K; Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of Medicine, Hyogo, Japan., Takeuchi T; Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan., Ichinose K; Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.; Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan., Kato M; Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan., Yanai R; Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan., Matsuo Y; Department of Rheumatology, Tokyo Kyosai Hospital, Tokyo, Japan.; Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan., Shimojima Y; Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan., Nishioka R; Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan., Okazaki R; Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan., Takata T; Division of Gastroenterology and Nephrology, Tottori University, Yonago, Japan., Ito T; Division of Nephrology, Department of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan., Moriyama M; Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan., Takatani A; Rheumatic Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan., Miyawaki Y; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan., Ito-Ihara T; The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan., Yajima N; Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.; Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan., Kawaguchi T; Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan., Fujioka K; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Fujii W; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Seno T; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Wada M; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Kohno M; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan., Kawahito Y; Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Jazyk:	angličtina
Zdroj:	Modern rheumatology [Mod Rheumatol] 2024 Jul 06; Vol. 34 (4), pp. 767-774.
DOI:	10.1093/mr/road099
Abstrakt:	Objectives: To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis. Methods: We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2-3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5-12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated. Results: Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94-19.8) for VLD and 5.1 (95% CI 1.21-21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly. Conclusion: Low-dose IVCY (7.5-12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg). (© Japan College of Rheumatology 2024. Published by Oxford University Press.)
Databáze:	MEDLINE
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