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Effects of cyclophosphamide on the prognosis of Japanese patients with renal vasculitis associated with anti-neutrophil cytoplasmic antibody-positive microscopic polyangiitis

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Abstract

Background

The aim of this study was to determine the efficacy of cyclophosphamide (CY) on anti-neutrophil cytoplasmic antibody (ANCA)-positive microscopic polyangiitis (MPA) with renal involvement in Japanese patients.

Methods

Eighty-two patients with newly diagnosed ANCA-positive MPA were enrolled in this retrospective study. Patients were divided into two groups based on whether they received combination therapy with a corticosteroid (CS) plus CY (CY group) or CS alone or with other therapies (non-CY group). The primary outcome was defined as the combination of death and end-stage renal disease (ESRD).

Results

The CY and non-CY groups included 29 and 53 patients, respectively. In the non-CY group, 31 patients were treated with CS alone, and 22 with a combination of CS and other therapeutics. The percentage of males and mean Birmingham vasculitis activity scores were higher in the CY group than those in the non-CY group, but other factors such as age, serum creatinine, serum albumin, or CRP at baseline were equivalent in the two groups. No differences were observed in remission rates using induction therapy for the two groups. However, the survival rate 5 years after induction therapy was lower in the CY group than in the non-CY group (0.50 vs. 0.73; P = 0.041), although the hazard ratio of CY for the primary outcome adjusted for all confounding factors was 1.321 [95 % confidence interval (CI), 0.662–2.637; P = 0.171].

Conclusions

CY may not have an additive effect on induction therapy with CS for Japanese patients with renal vasculitis associated with ANCA-positive MPA.

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Acknowledgments

This study was supported by a grant-in-aid by Ministry of Health, Labor and Welfare in Japan “Development of Clinical Research Fellowship” (PI: S. Fukuhara) (Grant no: H21-007).

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Authors and Affiliations

  1. Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan

    Masashi Iwabuchi, Yoshinori Tsuchiya, Yuji Oe, Toshinobu Sato & Yoshio Taguma

  2. Department of Nephrology, Iwate Prefectural Central Hospital, Ueda 1-4-1, Morioka, 020-0066, Japan

    Izaya Nakaya & Jun Soma

  3. Department of Pathology, Iwate Prefectural Central Hospital, Morioka, Japan

    Tsutomu Sakuma

  4. Division of Nephrology and Hypertension, St. Marianna University School of Medical Hospital, Kawasaki, Japan

    Yugo Shibagaki

  5. Department of Biostatistics, Tohoku University School of Medicine, Sendai, Japan

    Takuhiro Yamaguchi

  6. Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Shunichi Fukuhara

Authors
  1. Masashi Iwabuchi
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  2. Izaya Nakaya
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  3. Yoshinori Tsuchiya
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  4. Yugo Shibagaki
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  5. Takuhiro Yamaguchi
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  6. Shunichi Fukuhara
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  7. Yuji Oe
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  8. Tsutomu Sakuma
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  9. Toshinobu Sato
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  10. Yoshio Taguma
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  11. Jun Soma
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Corresponding author

Correspondence to Izaya Nakaya.

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The authors have declared that no conflict of interest exists.

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Iwabuchi, M., Nakaya, I., Tsuchiya, Y. et al. Effects of cyclophosphamide on the prognosis of Japanese patients with renal vasculitis associated with anti-neutrophil cytoplasmic antibody-positive microscopic polyangiitis. Clin Exp Nephrol 20, 712–719 (2016). https://doi.org/10.1007/s10157-015-1200-5

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  • DOI: https://doi.org/10.1007/s10157-015-1200-5

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