TY - JOUR
T1 - Association between hypogammaglobulinaemia and severe infections during induction therapy in ANCA-associated vasculitis
T2 - from J-CANVAS study
AU - Omura, Satoshi
AU - Kida, Takashi
AU - Noma, Hisashi
AU - Sunaga, Atsuhiko
AU - Kusuoka, Hiroaki
AU - Kadoya, Masatoshi
AU - Nakagomi, Daiki
AU - Abe, Yoshiyuki
AU - Takizawa, Naoho
AU - Nomura, Atsushi
AU - Kukida, Yuji
AU - Kondo, Naoya
AU - Yamano, Yasuhiko
AU - Yanagida, Takuya
AU - Endo, Koji
AU - Hirata, Shintaro
AU - Matsui, Kiyoshi
AU - Takeuchi, Tohru
AU - Ichinose, Kunihiro
AU - Kato, Masaru
AU - Yanai, Ryo
AU - Matsuo, Yusuke
AU - Shimojima, Yasuhiro
AU - Nishioka, Ryo
AU - Okazaki, Ryota
AU - Takata, Tomoaki
AU - Ito, Takafumi
AU - Moriyama, Mayuko
AU - Takatani, Ayuko
AU - Miyawaki, Yoshia
AU - Ito-Ihara, Toshiko
AU - Yajima, Nobuyuki
AU - Kawaguchi, Takashi
AU - Fukuda, Wataru
AU - Kawahito, Yutaka
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Objectives: To investigate the association between decreased serum IgG levels caused by remission-induction immunosuppressive therapy of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and the development of severe infections. Methods: We conducted a retrospective cohort study of patients with new-onset or severe relapsing AAV enrolled in the J-CANVAS registry, which was established at 24 referral sites in Japan. The minimum serum IgG levels up to 24 weeks and the incidence of severe infection up to 48 weeks after treatment initiation were evaluated. After multiple imputations for all explanatory variables, we performed the multivariate analysis using a Fine–Gray model to assess the association between low IgG (the minimum IgG levels <500 mg/dl) and severe infections. In addition, the association was expressed as a restricted cubic spline (RCS) and analysed by treatment subgroups. Results: Of 657 included patients (microscopic polyangiitis, 392; granulomatosis with polyangiitis, 139; eosinophilic granulomatosis with polyangiitis, 126), 111 (16.9%) developed severe infections. The minimum serum IgG levels were measured in 510 patients, of whom 77 (15.1%) had low IgG. After multiple imputations, the confounder-adjusted hazard ratio of low IgG for the incidence of severe infections was 1.75 (95% confidence interval: 1.03–3.00). The RCS revealed a U-shaped association between serum IgG levels and the incidence of severe infection with serum IgG 946 mg/dl as the lowest point. Subgroup analysis showed no obvious heterogeneity between treatment regimens. Conclusion: Regardless of treatment regimens, low IgG after remission-induction treatment was associated with the development of severe infections up to 48 weeks after treatment initiation.
AB - Objectives: To investigate the association between decreased serum IgG levels caused by remission-induction immunosuppressive therapy of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and the development of severe infections. Methods: We conducted a retrospective cohort study of patients with new-onset or severe relapsing AAV enrolled in the J-CANVAS registry, which was established at 24 referral sites in Japan. The minimum serum IgG levels up to 24 weeks and the incidence of severe infection up to 48 weeks after treatment initiation were evaluated. After multiple imputations for all explanatory variables, we performed the multivariate analysis using a Fine–Gray model to assess the association between low IgG (the minimum IgG levels <500 mg/dl) and severe infections. In addition, the association was expressed as a restricted cubic spline (RCS) and analysed by treatment subgroups. Results: Of 657 included patients (microscopic polyangiitis, 392; granulomatosis with polyangiitis, 139; eosinophilic granulomatosis with polyangiitis, 126), 111 (16.9%) developed severe infections. The minimum serum IgG levels were measured in 510 patients, of whom 77 (15.1%) had low IgG. After multiple imputations, the confounder-adjusted hazard ratio of low IgG for the incidence of severe infections was 1.75 (95% confidence interval: 1.03–3.00). The RCS revealed a U-shaped association between serum IgG levels and the incidence of severe infection with serum IgG 946 mg/dl as the lowest point. Subgroup analysis showed no obvious heterogeneity between treatment regimens. Conclusion: Regardless of treatment regimens, low IgG after remission-induction treatment was associated with the development of severe infections up to 48 weeks after treatment initiation.
KW - ANCA-associated vasculitis
KW - IgG
KW - cumulative incidence function
KW - hypogammaglobulinaemia
KW - interaction
KW - restricted cubic splines
KW - severe infections
UR - http://www.scopus.com/inward/record.url?scp=85178520585&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/kead138
DO - 10.1093/rheumatology/kead138
M3 - 学術論文
C2 - 36961329
AN - SCOPUS:85178520585
SN - 1462-0324
VL - 62
SP - 3924
EP - 3931
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 12
ER -