PMID- 37801552
OWN - NLM
STAT- Publisher
LR  - 20231006
IS  - 1439-7609 (Electronic)
IS  - 1439-7595 (Linking)
DP  - 2023 Oct 6
TI  - Optimal Dose of Intravenous Cyclophosphamide during remission induction therapy 
      in ANCA-associated vasculitis: a retrospective cohort study of J-CANVAS.
LID - road099 [pii]
LID - 10.1093/mr/road099 [doi]
AB  - OBJECTIVES: To identify the optimal dose of intravenous cyclophosphamide (IVCY) 
      for induction therapy for anti-neutrophil cytoplasmic antibody-associated 
      vasculitis (AAV). METHODS: We retrospectively assessed patients with AAV 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 were 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).
CI  - (c) Japan College of Rheumatology 2023. Published by Oxford University Press. All 
      rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
FAU - Sofue, Hideaki
AU  - Sofue H
AUID- ORCID: 0000-0002-9305-4790
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, 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 - Hirano, Aiko
AU  - Hirano A
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
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.
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  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, 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  - Division of Rheumatology, Department of Medicine, Showa University School of 
      Medicine, Tokyo, 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 - Fujioka, Kazuki
AU  - Fujioka K
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Fujii, Wataru
AU  - Fujii W
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Seno, Takahiro
AU  - Seno T
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Wada, Makoto
AU  - Wada M
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, Kyoto, Japan.
FAU - Kohno, Masataka
AU  - Kohno M
AD  - Inflammation and Immunology, Graduate School of Medical Science, Kyoto 
      Prefectural University of Medicine, 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
PT  - Journal Article
DEP - 20231006
PL  - England
TA  - Mod Rheumatol
JT  - Modern rheumatology
JID - 100959226
SB  - IM
OTO - NOTNLM
OT  - Antineutrophil cytoplasmic antibody-associated vasculitis
OT  - Cyclophosphamide
OT  - Intravenous cyclophosphamide
OT  - Restricted cubic spline
OT  - Severe infection
EDAT- 2023/10/06 18:41
MHDA- 2023/10/06 18:41
CRDT- 2023/10/06 14:13
PHST- 2023/08/08 00:00 [received]
PHST- 2023/09/19 00:00 [revised]
PHST- 2023/10/02 00:00 [accepted]
PHST- 2023/10/06 18:41 [medline]
PHST- 2023/10/06 18:41 [pubmed]
PHST- 2023/10/06 14:13 [entrez]
AID - 7293244 [pii]
AID - 10.1093/mr/road099 [doi]
PST - aheadofprint
SO  - Mod Rheumatol. 2023 Oct 6:road099. doi: 10.1093/mr/road099.