PMID- 36961329
OWN - NLM
STAT- MEDLINE
DCOM- 20231204
LR  - 20231217
IS  - 1462-0332 (Electronic)
IS  - 1462-0324 (Linking)
VI  - 62
IP  - 12
DP  - 2023 Dec 1
TI  - Association between hypogammaglobulinaemia and severe infections during induction 
      therapy in ANCA-associated vasculitis: from J-CANVAS study.
PG  - 3924-3931
LID - 10.1093/rheumatology/kead138 [doi]
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.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      British Society for Rheumatology. All rights reserved. For permissions, please 
      email: journals.permissions@oup.com.
FAU - Omura, Satoshi
AU  - Omura S
AUID- ORCID: 0000-0002-9187-2044
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
FAU - Kida, Takashi
AU  - Kida T
AUID- ORCID: 0000-0002-5740-8352
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Noma, Hisashi
AU  - Noma H
AUID- ORCID: 0000-0002-2520-9949
AD  - Department of Data Science, The Institute of Statistical Mathematics, Tokyo, 
      Japan.
FAU - Sunaga, Atsuhiko
AU  - Sunaga A
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
FAU - Kusuoka, Hiroaki
AU  - Kusuoka H
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
FAU - Kadoya, Masatoshi
AU  - Kadoya M
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
FAU - Nakagomi, Daiki
AU  - Nakagomi D
AUID- ORCID: 0000-0003-1682-9799
AD  - Department of Rheumatology, University of Yamanashi Hospital, Yamanashi, Japan.
FAU - Abe, Yoshiyuki
AU  - Abe Y
AD  - Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, 
      Japan.
FAU - Takizawa, Naoho
AU  - Takizawa N
AD  - Department of Rheumatology, Chubu Rosai Hospital, Nagoya, Japan.
FAU - Nomura, Atsushi
AU  - Nomura A
AD  - Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan.
FAU - Kukida, Yuji
AU  - Kukida Y
AD  - Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, 
      Kyoto, Japan.
FAU - Kondo, Naoya
AU  - Kondo N
AD  - Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan.
FAU - Yamano, Yasuhiko
AU  - Yamano Y
AD  - Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, 
      Japan.
FAU - Yanagida, Takuya
AU  - Yanagida T
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
AD  - Department of Hematology and Rheumatology, Kagoshima University Hospital, 
      Kagoshima, Japan.
FAU - Endo, Koji
AU  - Endo K
AD  - Department of General Internal Medicine, Tottori Prefectural Central Hospital, 
      Tottori, Japan.
FAU - Hirata, Shintaro
AU  - Hirata S
AUID- ORCID: 0000-0002-2474-9943
AD  - Department of Clinical Immunology and Rheumatology, Hiroshima University 
      Hospital, Hiroshima, Japan.
FAU - Matsui, Kiyoshi
AU  - Matsui K
AD  - Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical 
      University School of Medicine, Hyogo, Japan.
FAU - Takeuchi, Tohru
AU  - Takeuchi T
AUID- ORCID: 0000-0002-0065-929X
AD  - Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical 
      University, Osaka, Japan.
FAU - Ichinose, Kunihiro
AU  - Ichinose K
AUID- ORCID: 0000-0001-8794-7106
AD  - Department of Immunology and Rheumatology, Division of Advanced Preventive 
      Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 
      Nagasaki, Japan.
AD  - Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, 
      Japan.
FAU - Kato, Masaru
AU  - Kato M
AUID- ORCID: 0000-0002-2023-6585
AD  - Department of Rheumatology, Endocrinology and Nephrology, Graduate School of 
      Medicine, Hokkaido University, Sapporo, Japan.
FAU - Yanai, Ryo
AU  - Yanai R
AD  - Division of Rheumatology, Department of Medicine, Showa University School of 
      Medicine, Tokyo, Japan.
FAU - Matsuo, Yusuke
AU  - Matsuo Y
AD  - Department of Rheumatology, Tokyo Kyosai Hospital, Tokyo, Japan.
AD  - Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo 
      Medical and Dental University, Tokyo, Japan.
FAU - Shimojima, Yasuhiro
AU  - Shimojima Y
AUID- ORCID: 0000-0001-7100-1121
AD  - Department of Medicine (Neurology and Rheumatology), Shinshu University School of 
      Medicine, Matsumoto, Japan.
FAU - Nishioka, Ryo
AU  - Nishioka R
AUID- ORCID: 0000-0001-8654-7311
AD  - Department of Rheumatology, Graduate School of Medical Science, Kanazawa 
      University, Kanazawa, Japan.
FAU - Okazaki, Ryota
AU  - Okazaki R
AD  - Division of Respiratory Medicine and Rheumatology, Department of 
      Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 
      Yonago, Japan.
FAU - Takata, Tomoaki
AU  - Takata T
AD  - Division of Gastroenterology and Nephrology, Tottori University, Yonago, Japan.
FAU - Ito, Takafumi
AU  - Ito T
AD  - Division of Nephrology, Shimane University Hospital, Shimane, Japan.
FAU - Moriyama, Mayuko
AU  - Moriyama M
AD  - Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, 
      Japan.
FAU - Takatani, Ayuko
AU  - Takatani A
AD  - Rheumatic Disease Center, Sasebo Chuo Hospital, Nagasaki, Japan.
FAU - Miyawaki, Yoshia
AU  - Miyawaki Y
AD  - Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama 
      University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 
      Okayama, Japan.
FAU - Ito-Ihara, Toshiko
AU  - Ito-Ihara T
AD  - The Clinical and Translational Research Center, University Hospital, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Yajima, Nobuyuki
AU  - Yajima N
AUID- ORCID: 0000-0002-8292-3962
AD  - Department of Rheumatology, Endocrinology and Nephrology, Graduate School of 
      Medicine, Hokkaido University, Sapporo, Japan.
AD  - Department of Healthcare Epidemiology, Kyoto University Graduate School of 
      Medicine and Public Health, Kyoto, Japan.
AD  - Center for Innovative Research for Communities and Clinical Excellence, Fukushima 
      Medical University, Fukushima, Japan.
FAU - Kawaguchi, Takashi
AU  - Kawaguchi T
AD  - Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, 
      Tokyo, Japan.
FAU - Fukuda, Wataru
AU  - Fukuda W
AD  - Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, 
      Kyoto, Japan.
FAU - Kawahito, Yutaka
AU  - Kawahito Y
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
LA  - eng
GR  - Japan Society for the Promotion of Science/
GR  - JP22K16348/KAKENHI/
PT  - Journal Article
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Immunoglobulin G)
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
SB  - IM
MH  - Humans
MH  - *Granulomatosis with Polyangiitis/drug therapy
MH  - *Churg-Strauss Syndrome
MH  - Retrospective Studies
MH  - *Agammaglobulinemia/chemically induced
MH  - Induction Chemotherapy
MH  - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy
MH  - *Microscopic Polyangiitis/drug therapy
MH  - Immunoglobulin G/therapeutic use
MH  - Antibodies, Antineutrophil Cytoplasmic
OTO - NOTNLM
OT  - ANCA-associated vasculitis
OT  - IgG
OT  - cumulative incidence function
OT  - hypogammaglobulinaemia
OT  - interaction
OT  - restricted cubic splines
OT  - severe infections
EDAT- 2023/03/25 06:00
MHDA- 2023/12/04 12:41
CRDT- 2023/03/24 10:08
PHST- 2022/10/14 00:00 [received]
PHST- 2023/03/15 00:00 [accepted]
PHST- 2023/12/04 12:41 [medline]
PHST- 2023/03/25 06:00 [pubmed]
PHST- 2023/03/24 10:08 [entrez]
AID - 7085588 [pii]
AID - 10.1093/rheumatology/kead138 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2023 Dec 1;62(12):3924-3931. doi: 
      10.1093/rheumatology/kead138.