PMID- 16399845
OWN - NLM
STAT- MEDLINE
DCOM- 20060804
LR  - 20220331
IS  - 1462-0324 (Print)
IS  - 1462-0324 (Linking)
VI  - 45
IP  - 6
DP  - 2006 Jun
TI  - Prediction of relapses in PR3-ANCA-associated vasculitis by assessing responses 
      of ANCA titres to treatment.
PG  - 724-9
AB  - OBJECTIVE: We performed a retrospective evaluation of whether c-ANCA titres 
      (indirect immunofluorescence) and anti-proteinase 3 (PR3)-ANCA levels (ELISA) at 
      diagnosis and following immunosuppressive treatment are predictive of relapse of 
      ANCA-associated vasculitis. METHODS: Patients diagnosed with PR3-ANCA-associated 
      vasculitis between 1991 and 2002, with at least 2 yr of follow-up, and treated 
      with cyclophosphamide and corticosteroids only (1991-1996) or switched to 
      azathioprine after induction of remission with cyclophosphamide and 
      corticosteroids (1997-2002) were included. ANCA were assessed by 
      immunofluorescence and direct PR3-specific ELISA at diagnosis and 3, 6, 12, 18 
      and 24 months after diagnosis. Actuarial relapse-free survival was analysed with 
      the log rank test. RESULTS: We studied 87 patients positive for PR3-ANCA: 46 were 
      on cyclophosphamide maintenance therapy and 41 switched to azathioprine. Overall 
      actuarial relapse-free survival was 72% at 2 yr and 34% at 5 yr. Relapse-free 
      survival did not differ between patients on cyclophosphamide maintenance and 
      patients switched to azathioprine maintenance (P = 0.34). Patients who became and 
      stayed negative for c-ANCA (immunofluorescence) or PR3-ANCA (ELISA) until 24 
      months after diagnosis had a lower risk of relapse (P = 0.01 and P = 0.02, 
      respectively). Positive c-ANCA (immunofluorescence) titres at 3 [relative risk 
      (RR) 2.0; 95% confidence interval (CI) 1.2-3.8], 12 (RR 1.9; 95% CI 1.1-3.3), 18 
      (RR 2.9; 95% CI 1.3-4.6) and 24 months (RR 2.6; 95% CI 1.2-5.0) were 
      significantly associated with relapse within 5 yr after diagnosis. PR3-ANCA 
      levels >10 U/ml at 18 (RR 2.7, 95% CI 1.1-4.3) and 24 months (RR 4.6; 95% CI 
      1.2-6.3) were predictive of relapse within 5 yr. In the azathioprine group, a 
      positive c-ANCA titre at the time of switching to azathioprine (RR 2.2; 95% CI 
      1.0-5.4) was associated with relapse. CONCLUSION: Positive c-ANCA 
      (immunofluorescence) and PR3-ANCA (ELISA) titres during early follow-up identify 
      patients at increased risk of relapse.
FAU - Sanders, J-S F
AU  - Sanders JS
AD  - Division of Clinical Immunology, University Medical Center Groningen, University 
      of Groningen, Hanzeplein 1, 9700 GZ Groningen, The Netherlands. 
      j.sanders@int.umcg.nl
FAU - Huitma, M G
AU  - Huitma MG
FAU - Kallenberg, C G M
AU  - Kallenberg CG
FAU - Stegeman, C A
AU  - Stegeman CA
LA  - eng
PT  - Journal Article
DEP - 20060106
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 0 (Biomarkers)
RN  - 0 (Immunosuppressive Agents)
RN  - EC 3.4.21.- (Serine Endopeptidases)
RN  - EC 3.4.21.76 (Myeloblastin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antibodies, Antineutrophil Cytoplasmic/*blood
MH  - Biomarkers/blood
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Epidemiologic Methods
MH  - Female
MH  - Fluorescent Antibody Technique, Indirect
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myeloblastin
MH  - Recurrence
MH  - Serine Endopeptidases/*immunology
MH  - Vasculitis/drug therapy/*immunology
EDAT- 2006/01/10 09:00
MHDA- 2006/08/05 09:00
CRDT- 2006/01/10 09:00
PHST- 2006/01/10 09:00 [pubmed]
PHST- 2006/08/05 09:00 [medline]
PHST- 2006/01/10 09:00 [entrez]
AID - kei272 [pii]
AID - 10.1093/rheumatology/kei272 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2006 Jun;45(6):724-9. doi: 10.1093/rheumatology/kei272. 
      Epub 2006 Jan 6.