Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies

Ken Ei Sada; Keiji Ohashi; Yosuke Asano; Keigo Hayashi; Michiko Morishita; Haruki Watanabe; Yoshinori Matsumoto; Shouichi Fujimoto; Yoshinari Takasaki; Kunihiro Yamagata; Shogo Banno; Hiroaki Dobashi; Koichi Amano; Masayoshi Harigai; Yoshihiro Arimura; Hirofumi Makino; Joichi Usui; Tatsuya Atsumi; Takahiko Sugihara; Seiichi Matsuo; Hitoshi Sugiyama; Akihiro Ishizu; Takao Fujii; Yasunori Okada; Sakae Homma; Naotake Tsuboi; Shunichi Kumagai; Eri Muso; Yohko Murakawa; Shogo Banno; Hitoshi Hasegawa; Wako Yumura; Hiroaki Matsubara; Masaharu Yoshida; Kensei Katsuoka; Noriyoshi Ogawa; Atsushi Komatsuda; Satoshi Ito; Atsushi Kawakami; Izaya Nakaya; Takao Saito; Takafumi Ito; Nobuhito Hirawa; Masahiro Yamamura; Masaaki Nakano; Kosaku Nitta; Makoto Ogura; Taio Naniwa; Shoichi Ozaki; Junichi Hirahashi; Tatsuo Hosoya; Takashi Wada; Satoshi Horikoshi; Yasushi Kawaguchi; Taichi Hayashi; Tsuyoshi Watanabe; Daijo Inaguma; Kazuhiko Tsuruya; Noriyuki Homma; Tsutomu Takeuchi; Naoki Nakagawa; Shinichi Takeda; Ritsuko Katafuchi; Masayuki Iwano; Masaki Kobayashi

doi:10.1186/s13075-020-02341-6

Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies

Ken Ei Sada, Keiji Ohashi, Yosuke Asano, Keigo Hayashi, Michiko Morishita, Haruki Watanabe, Yoshinori Matsumoto, Shouichi Fujimoto, Yoshinari Takasaki, Kunihiro Yamagata, Shogo Banno, Hiroaki Dobashi, Koichi Amano, Masayoshi Harigai, Yoshihiro Arimura, Hirofumi Makino, Joichi Usui, Tatsuya Atsumi, Takahiko Sugihara, Seiichi MatsuoHitoshi Sugiyama, Akihiro Ishizu, Takao Fujii, Yasunori Okada, Sakae Homma, Naotake Tsuboi, Shunichi Kumagai, Eri Muso, Yohko Murakawa, Shogo Banno, Hitoshi Hasegawa, Wako Yumura, Hiroaki Matsubara, Masaharu Yoshida, Kensei Katsuoka, Noriyoshi Ogawa, Atsushi Komatsuda, Satoshi Ito, Atsushi Kawakami, Izaya Nakaya, Takao Saito, Takafumi Ito, Nobuhito Hirawa, Masahiro Yamamura, Masaaki Nakano, Kosaku Nitta, Makoto Ogura, Taio Naniwa, Shoichi Ozaki, Junichi Hirahashi, Tatsuo Hosoya, Takashi Wada, Satoshi Horikoshi, Yasushi Kawaguchi, Taichi Hayashi, Tsuyoshi Watanabe, Daijo Inaguma, Kazuhiko Tsuruya, Noriyuki Homma, Tsutomu Takeuchi, Naoki Nakagawa, Shinichi Takeda, Ritsuko Katafuchi, Masayuki Iwano, Masaki Kobayashi

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods: Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day. Results: Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00-1.35) was a predictor for diabetes. Conclusion: A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.

Original language	English
Article number	236
Journal	Arthritis Research and Therapy
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s13075-020-02341-6
Publication status	Published - 2020 Oct 12

Keywords

ANCA-associated vasculitis
Chronic damage
Elderly patients
Glucocorticoids

ASJC Scopus subject areas

Rheumatology
Immunology and Allergy
Immunology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s13075-020-02341-6

Cite this

Sada, K. E., Ohashi, K., Asano, Y., Hayashi, K., Morishita, M., Watanabe, H., Matsumoto, Y., Fujimoto, S., Takasaki, Y., Yamagata, K., Banno, S., Dobashi, H., Amano, K., Harigai, M., Arimura, Y., Makino, H., Usui, J., Atsumi, T., Sugihara, T., ... Kobayashi, M. (2020). Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies. Arthritis Research and Therapy, 22(1), [236]. https://doi.org/10.1186/s13075-020-02341-6

Sada, KE, Ohashi, K, Asano, Y, Hayashi, K, Morishita, M, Watanabe, H, Matsumoto, Y, Fujimoto, S, Takasaki, Y, Yamagata, K, Banno, S, Dobashi, H, Amano, K, Harigai, M, Arimura, Y, Makino, H, Usui, J, Atsumi, T, Sugihara, T, Matsuo, S, Sugiyama, H, Ishizu, A, Fujii, T, Okada, Y, Homma, S, Tsuboi, N, Kumagai, S, Muso, E, Murakawa, Y, Banno, S, Hasegawa, H, Yumura, W, Matsubara, H, Yoshida, M, Katsuoka, K, Ogawa, N, Komatsuda, A, Ito, S, Kawakami, A, Nakaya, I, Saito, T, Ito, T, Hirawa, N, Yamamura, M, Nakano, M, Nitta, K, Ogura, M, Naniwa, T, Ozaki, S, Hirahashi, J, Hosoya, T, Wada, T, Horikoshi, S, Kawaguchi, Y, Hayashi, T, Watanabe, T, Inaguma, D, Tsuruya, K, Homma, N, Takeuchi, T, Nakagawa, N, Takeda, S, Katafuchi, R, Iwano, M & Kobayashi, M 2020, 'Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies', Arthritis Research and Therapy, vol. 22, no. 1, 236. https://doi.org/10.1186/s13075-020-02341-6

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title = "Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies",

abstract = "Background: It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods: Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day. Results: Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00-1.35) was a predictor for diabetes. Conclusion: A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.",

keywords = "ANCA-associated vasculitis, Chronic damage, Elderly patients, Glucocorticoids",

author = "Sada, {Ken Ei} and Keiji Ohashi and Yosuke Asano and Keigo Hayashi and Michiko Morishita and Haruki Watanabe and Yoshinori Matsumoto and Shouichi Fujimoto and Yoshinari Takasaki and Kunihiro Yamagata and Shogo Banno and Hiroaki Dobashi and Koichi Amano and Masayoshi Harigai and Yoshihiro Arimura and Hirofumi Makino and Joichi Usui and Tatsuya Atsumi and Takahiko Sugihara and Seiichi Matsuo and Hitoshi Sugiyama and Akihiro Ishizu and Takao Fujii and Yasunori Okada and Sakae Homma and Naotake Tsuboi and Shunichi Kumagai and Eri Muso and Yohko Murakawa and Shogo Banno and Hitoshi Hasegawa and Wako Yumura and Hiroaki Matsubara and Masaharu Yoshida and Kensei Katsuoka and Noriyoshi Ogawa and Atsushi Komatsuda and Satoshi Ito and Atsushi Kawakami and Izaya Nakaya and Takao Saito and Takafumi Ito and Nobuhito Hirawa and Masahiro Yamamura and Masaaki Nakano and Kosaku Nitta and Makoto Ogura and Taio Naniwa and Shoichi Ozaki and Junichi Hirahashi and Tatsuo Hosoya and Takashi Wada and Satoshi Horikoshi and Yasushi Kawaguchi and Taichi Hayashi and Tsuyoshi Watanabe and Daijo Inaguma and Kazuhiko Tsuruya and Noriyuki Homma and Tsutomu Takeuchi and Naoki Nakagawa and Shinichi Takeda and Ritsuko Katafuchi and Masayuki Iwano and Masaki Kobayashi",

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doi = "10.1186/s13075-020-02341-6",

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TY - JOUR

T1 - Treatment-related damage in elderly-onset ANCA-associated vasculitis

T2 - Safety outcome analysis of two nationwide prospective cohort studies

AU - Sada, Ken Ei

AU - Ohashi, Keiji

AU - Asano, Yosuke

AU - Hayashi, Keigo

AU - Morishita, Michiko

AU - Watanabe, Haruki

AU - Matsumoto, Yoshinori

AU - Fujimoto, Shouichi

AU - Takasaki, Yoshinari

AU - Yamagata, Kunihiro

AU - Banno, Shogo

AU - Dobashi, Hiroaki

AU - Amano, Koichi

AU - Harigai, Masayoshi

AU - Arimura, Yoshihiro

AU - Makino, Hirofumi

AU - Usui, Joichi

AU - Atsumi, Tatsuya

AU - Sugihara, Takahiko

AU - Matsuo, Seiichi

AU - Sugiyama, Hitoshi

AU - Ishizu, Akihiro

AU - Fujii, Takao

AU - Okada, Yasunori

AU - Homma, Sakae

AU - Tsuboi, Naotake

AU - Kumagai, Shunichi

AU - Muso, Eri

AU - Murakawa, Yohko

AU - Banno, Shogo

AU - Hasegawa, Hitoshi

AU - Yumura, Wako

AU - Matsubara, Hiroaki

AU - Yoshida, Masaharu

AU - Katsuoka, Kensei

AU - Ogawa, Noriyoshi

AU - Komatsuda, Atsushi

AU - Ito, Satoshi

AU - Kawakami, Atsushi

AU - Nakaya, Izaya

AU - Saito, Takao

AU - Ito, Takafumi

AU - Hirawa, Nobuhito

AU - Yamamura, Masahiro

AU - Nakano, Masaaki

AU - Nitta, Kosaku

AU - Ogura, Makoto

AU - Naniwa, Taio

AU - Ozaki, Shoichi

AU - Hirahashi, Junichi

AU - Hosoya, Tatsuo

AU - Wada, Takashi

AU - Horikoshi, Satoshi

AU - Kawaguchi, Yasushi

AU - Hayashi, Taichi

AU - Watanabe, Tsuyoshi

AU - Inaguma, Daijo

AU - Tsuruya, Kazuhiko

AU - Homma, Noriyuki

AU - Takeuchi, Tsutomu

AU - Nakagawa, Naoki

AU - Takeda, Shinichi

AU - Katafuchi, Ritsuko

AU - Iwano, Masayuki

AU - Kobayashi, Masaki

PY - 2020/10/12

Y1 - 2020/10/12

N2 - Background: It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods: Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day. Results: Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00-1.35) was a predictor for diabetes. Conclusion: A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.

AB - Background: It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods: Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day. Results: Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00-1.35) was a predictor for diabetes. Conclusion: A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.

KW - ANCA-associated vasculitis

KW - Chronic damage

KW - Elderly patients

KW - Glucocorticoids

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U2 - 10.1186/s13075-020-02341-6

DO - 10.1186/s13075-020-02341-6

M3 - Article

C2 - 33046139

AN - SCOPUS:85092565977

SN - 1478-6354

VL - 22

JO - Arthritis Research and Therapy

JF - Arthritis Research and Therapy

IS - 1

M1 - 236

ER -

Treatment-related damage in elderly-onset ANCA-associated vasculitis: Safety outcome analysis of two nationwide prospective cohort studies

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Keywords

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UN SDGs

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