2017 Clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis for the management of ANCA-associated vasculitis

Harigai, Masayoshi; Nagasaka, Kenji; Amano, Koichi; Bando, Masashi; Dobashi, Hiroaki; Kawakami, Tamihiro; Kishibe, Kan; Murakawa, Yohko; Usui, Joichi; Wada, Takashi; Tanaka, Eiichi; Nango, Eishu; Nakayama, Takeo; Tsutsumino, Michi; Yamagata, Kunihiro; Homma, Sakae; Arimua, Yoshihiro

doi:10.1080/14397595.2018.1500437

Cited by 53 publications

(51 citation statements)

References 35 publications

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“…In Japan, Hirayama et al reported that the 1‐year survival rate was 56.2% and the 5‐year survival rate was 41.5% in 175 DAH patients with rapidly progressive glomerulonephritis, where 50 of the 175 patients received PLEX therapy . Several studies reported the effectiveness of PLEX in DAH patients with AAV , and clinical guidelines have recommended PLEX for this population . Although the 1‐year survival in our study was only 26%, one likely reason is that very few patients (20%) received PLEX therapy.…”

Section: Discussionmentioning

confidence: 52%

“…Gallagher (19). Several studies reported the effectiveness of PLEX in DAH patients with AAV (20-28), and clinical guidelines have recommended PLEX for this population (7)(8)(9). Although the 1-year survival in our study was only 26%, one likely reason is that very few patients (20%) received PLEX therapy.…”

Section: Discussionmentioning

confidence: 60%

“…The usage rate of cyclophosphamide may not be the direct bias for survivability in this comparison. However, cyclophosphamide is one of the key drugs for the standard therapy for AAV with or without DAH . Regardless of the results of this study, cyclophosphamide should be used more in Japanese patients with AAV.…”

Section: Discussionmentioning

confidence: 84%

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Plasma Exchange Therapy to Reduce Mortality in Japanese Patients With Diffuse Alveolar Hemorrhage and Microscopic Polyangiitis

et al. 2019

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Diffuse alveolar hemorrhage (DAH) is well known as a serious complication of microscopic polyangiitis (MPA). We examined the effectiveness of plasma exchange (PLEX) therapy to reduce mortality in Japanese DAH patients with MPA. This retrospective, double‐center, observational cohort study included 20 DAH patients with MPA who were admitted to Juntendo University Hospital or Juntendo Koto Geriatric Medical Center between April 1998 and March 2018. The primary outcome was non–disease‐specific mortality. The 1‐year survival rate of patients with PLEX therapy (N = 4) was higher than that of patients with conventional therapy (N = 16, 75% and 13%, respectively, P = 0.037). Higher values of the 1996 Five‐Factor Score (FFS) and 2009 FFS were associated with increased mortality, with hazard ratios of 2.29 (P = 0.040) and 2.41 (P = 0.043), respectively, by Cox univariate analysis. We investigated PLEX therapy for reducing mortality in DAH patients with MPA, and the 1996 FFS and 2009 FFS were both independent prognostic factors.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 60%

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Plasma Exchange Therapy to Reduce Mortality in Japanese Patients With Diffuse Alveolar Hemorrhage and Microscopic Polyangiitis

et al. 2019

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“…AAV develops in patients with unique genetic backgrounds, and is classified into three types: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA) . Prognosis in patients with AAV has recently been improved by remission‐induction treatment using immunosuppressive agents such as cyclophosphamide and high‐dose corticosteroids (CS) . However, it has been reported that patients with AAV have significantly higher mortality than the general population, with the most common cause of death being infection .…”

Section: Introductionmentioning

confidence: 99%

Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody‐associated vasculitis, using a Japanese health insurance database

et al. 2019

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Aim:Opportunistic infections (OIs) adversely affect outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). This study aimed to identify the incidence proportion of risk factors for OIs in patients with AAV who were on remission-induction therapy, using a Japanese health insurance database.Method: This retrospective longitudinal population-based study was conducted using claims data provided by Medical Data Vision Co., Ltd. We defined individuals as AAV cases receiving remission-induction therapy if they met all of the following criteria: (a) having OIs with at least 1 specified International Statistical Classification of Diseases and Related Health Problems, 10th Revision code (M300, M301, M313, or M318); (b) receiving at least 1 prescription of oral corticosteroids (CS) with prednisolone (PSL)-equivalent dosage ≥30 mg/d, CS pulse therapy, immunosuppressive agents or rituximab during hospitalization between April 2008 and April 2017; and (c)at least 7 days of hospitalization while on the above-mentioned therapies. We calculated incidence and proportion of OIs during the year following remission-induction therapy and the adjusted odds ratio (OR) using a logistic regression model. Results:We included 2299 patients with AAV in this study. OIs occurred in 460 patients (20.0%), with the most frequently occurring OI being cytomegalovirus infection (n = 122, 6.5%). After adjusting for covariates, age by decade (OR 1.24, 95% CI: 1.12-1.36), daily PSL dose per 10 mg (OR 1.16, 95% CI: 1.08-1.25), and CS pulse therapy (OR 1.29, 95% CI: 1.04-1.60) were found to be significantly associated with occurrence of OIs. Conclusion:Older age and corticosteroid use were found to be significant risk factors for OIs in patients with AAV on remission-induction therapy, using a health insurance database. K E Y W O R D S antineutrophil cytoplasmic antibody-associated vasculitis, drug treatment opportunistic infection, epidemiology, risk S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Sakai R, Tanaka E, Nishina H, Suzuki M, Yamanaka H, Harigai M. Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody-associated vasculitis, using a Japanese health insurance database. Int J

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confidence: 99%

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

et al. 2019

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We aimed to investigate the efficacy of plasma exchange on severe anti‐neutrophil cytoplasmic antibody‐associated vasculitis (AAV). Of 182 patients with AAV in our hospital, 12 patients with life‐threatening organ damage (rapidly progressive glomerulonephritis and/or diffuse alveolar hemorrhage) underwent centrifuge‐based therapeutic plasma exchange and immunosuppressive therapy. Twenty‐four patients matched for age, serum creatinine, and severity of vasculitis, who received high‐dose glucocorticoids with or without immunosuppressants, were included in the nonplasma exchange group. Renal survival rate at 2 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.524). Mortality rate at 5 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.631). In this retrospective study, we could not show the significant differences in the renal survival rate and survival rate between the two groups.

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2017 Clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis for the management of ANCA-associated vasculitis

Abstract: The revised CPG has demonstrated evidence-based treatment recommendations for AAV.

Cited by 53 publications

References 35 publications

Plasma Exchange Therapy to Reduce Mortality in Japanese Patients With Diffuse Alveolar Hemorrhage and Microscopic Polyangiitis

Plasma Exchange Therapy to Reduce Mortality in Japanese Patients With Diffuse Alveolar Hemorrhage and Microscopic Polyangiitis

Risk of opportunistic infections in patients with antineutrophil cytoplasmic antibody‐associated vasculitis, using a Japanese health insurance database

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

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