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

研究成果: Article査読

3 被引用数 (Scopus)

抄録

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.

本文言語English
論文番号236
ジャーナルArthritis Research and Therapy
22
1
DOI
出版ステータスPublished - 2020 10 12

ASJC Scopus subject areas

  • リウマチ学
  • 免疫アレルギー学
  • 免疫学

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