ANCA as a Predictor of Relapse

Kemna, Michael J.; Damoiseaux, Jan; Austen, Jos; Winkens, Björn; Peters, J. E.; Paassen, Pieter van; Tervaert, Jan Willem Cohen

doi:10.1681/asn.2013111233

Cited by 191 publications

(194 citation statements)

References 35 publications

(52 reference statements)

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“…One study found that a combination of a rise of PR3-ANCA and C-ANCA was most predictive of a relapse [88]. However, this was not confirmed by a later study [27]. Preliminary results suggest that the second-and third-generation tests predict relapses better than IF tests and/or first-generation tests [2,80].…”

Section: Serial Anca Measurements -Heterogeneity Between Studiesmentioning

confidence: 92%

“…For example, it can be difficult to differentiate minor symptoms, such as fever or arthralgia that are caused by vasculitis from symptoms that are caused by an infection. Therefore, in our studies, a minor relapse was diagnosed only if symptoms were refractory to appropriate antibiotic therapy [27]. In addition, a relapse was defined as reoccurrence or new onset of …”

Section: Definitions Of Remission and Relapsementioning

confidence: 99%

“…At present, second-(capture ELISA) and third (anchor ELISA)-generation tests are available [2]. For serial ANCA measurements, an ANCA rise as measured by ELISA is a stronger predictor of a relapse compared to a rise as measured by IIF [27,88]. One study found that a combination of a rise of PR3-ANCA and C-ANCA was most predictive of a relapse [88].…”

Section: Serial Anca Measurements -Heterogeneity Between Studiesmentioning

confidence: 99%

“…A higher association was observed in patients who were tested at least 4 times per year (HR 6.40 [95% CI 3.45-11.88]) compared to patients who were tested less frequently (HR 2.13 [95% CI 0.67-6.77]) [27]. However, more frequent sampling may not always be feasible [95].…”

Section: Serial Anca Measurements -Heterogeneity Between Studiesmentioning

confidence: 99%

“…To resolve this issue, ANCA rises have previously been defined using the slope of the rise (e.g. doubling of the ANCA rise in 3 months) [27,95]. Another study has retrospectively calculated the peak of the ANCA rise, which cannot be used in a prospective study [76].…”

Section: Serial Anca Measurements -Heterogeneity Between Studiesmentioning

confidence: 99%

See 4 more Smart Citations

Maintaining remission in patients with granulomatosis with polyangiitis or microscopic polyangiitis: the role of ANCA

Kemna¹,

Paassen²,

Damoiseaux³

et al. 2017

Expert Opinion on Orphan Drugs

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Introduction: Granulomatosis with Polyangiitis (GPA; formerly Wegener's) and Microscopic Polyangiitis (MPA) are inflammatory disease entities affecting small to medium vessels. They are characterized by the presence of anti-neutrophil cytoplasmic antibodies (ANCA) and are frequently grouped together with Eosinophilic Granulomatosis with Polyangiitis (EGPA; formerly Churg Strauss Syndrome) under the term ANCA-associated Vasculitis (AAV). Due to effective immunosuppressive therapy that was introduced more than 45 years ago, AAV has become a chronic disease in which relapses occur frequently during maintenance treatment or later on after all immunosuppressive therapy is stopped. Since relapses are associated with morbidity and mortality, early detection and prevention of relapses is of great importance. Areas covered: This review focuses on the potential strategies to guide maintenance therapy in patients with GPA or MPA, with an emphasis on patient classifications and the role of serial ANCA measurements. Expert opinion: Risk factors for relapses, e.g., genetic background of the patient, have been studied during the last three decades. Only few of these risk factors directly influence the management of patients. One potentially important factor that may influence therapeutic decisions in AAV patients is serial measurement of ANCA. Recently, it became clear that serial ANCA measurement is an attractive approach in AAV patients with (a history of) capillaritis, e.g., renal involvement or alveolar haemorrhage, but not in patients with more limited disease. Whether ANCA rises can be used to guide therapy andhence-to prevent relapses has been a great debate during the last three decades. At present, we conclude that small studies do support such an approach but that these findings require further validation in larger randomized clinical trials. ARTICLE HISTORY

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