TY - JOUR
T1 - Optimal dose of intravenous cyclophosphamide during remission induction therapy in ANCA-associated vasculitis
T2 - A retrospective cohort study of J-CANVAS
AU - Sofue, Hideaki
AU - Kida, Takashi
AU - Hirano, Aiko
AU - Omura, Satoshi
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 - Fujioka, Kazuki
AU - Fujii, Wataru
AU - Seno, Takahiro
AU - Wada, Makoto
AU - Kohno, Masataka
AU - Kawahito, Yutaka
N1 - Publisher Copyright:
© Japan College of Rheumatology 2024.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - Objectives: To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis. Methods: We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2–3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5–12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated. Results: Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94–19.8) for VLD and 5.1 (95% CI 1.21–21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly. Conclusion: Low-dose IVCY (7.5–12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg).
AB - Objectives: To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis. Methods: We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2–3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5–12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated. Results: Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94–19.8) for VLD and 5.1 (95% CI 1.21–21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly. Conclusion: Low-dose IVCY (7.5–12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg).
KW - Antineutrophil cytoplasmic antibody-associated vasculitis
KW - cyclophosphamide
KW - intravenous cyclophosphamide
KW - restricted cubic spline
KW - severe infection
UR - http://www.scopus.com/inward/record.url?scp=85192508324&partnerID=8YFLogxK
U2 - 10.1093/mr/road099
DO - 10.1093/mr/road099
M3 - 学術論文
C2 - 37801552
AN - SCOPUS:85192508324
SN - 1439-7595
VL - 34
SP - 767
EP - 774
JO - Modern Rheumatology
JF - Modern Rheumatology
IS - 4
ER -