Antiproteinase-3 (PR3)-Antineutrophil Cytoplasmic Atibody (ANCA) as a Predictor for Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Meta-Analysis

2022 ◽  
Vol 9 ◽  
Author(s):  
Jiaojiao Gong ◽  
Zhihui Quan ◽  
Ruiqiong Wang ◽  
Guotao Chen
Keyword(s):  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody

scholarly journals Cross-phenotype analysis of Immunochip data identifies KDM4C as a relevant locus for the development of systemic vasculitis

2018 ◽  
Vol 77 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Lourdes Ortiz-Fernández ◽  
Francisco David Carmona ◽  
Raquel López-Mejías ◽  
Maria Francisca González-Escribano ◽  
Paul A Lyons ◽  
...  
Keyword(s):  
Systemic Vasculitis ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Control Of Gene Expression ◽  
Immune Mediated ◽  
Phenotype Analysis ◽  
Functional Consequences ◽  
Shared Genetic

ObjetiveSystemic vasculitides represent a heterogeneous group of rare complex diseases of the blood vessels with a poorly understood aetiology. To investigate the shared genetic component underlying their predisposition, we performed the first cross-phenotype meta-analysis of genetic data from different clinically distinct patterns of vasculitis.MethodsImmunochip genotyping data from 2465 patients diagnosed with giant cell arteritis, Takayasu’s arteritis, antineutrophil cytoplasmic antibody-associated vasculitis or IgA vasculitis as well as 4632 unaffected controls were analysed to identify common susceptibility loci for vasculitis development. The possible functional consequences of the associated variants were interrogated using publicly available annotation data.ResultsThe strongest association signal corresponded with an intergenic polymorphism located between HLA-DQB1 and HLA-DQA2 (rs6932517, P=4.16E-14, OR=0.74). This single nucleotide polymorphism is in moderate linkage disequilibrium with the disease-specific human leucocyte antigen (HLA) class II associations of each type of vasculitis and could mark them. Outside the HLA region, we identified the KDM4C gene as a common risk locus for vasculitides (highest peak rs16925200, P=6.23E-07, OR=1.75). This gene encodes a histone demethylase involved in the epigenetic control of gene expression.ConclusionsThrough a combined analysis of Immunochip data, we have identified KDM4C as a new risk gene shared between systemic vasculitides, consistent with the increasing evidences of the crucial role that the epigenetic mechanisms have in the development of complex immune-mediated conditions.

scholarly journals Efficacy of mycophenolate mofetil as a remission induction therapy in antineutrophil cytoplasmic antibody: associated vasculitis—a meta-analysis

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001195 ◽  
Author(s):  
Kentaro Kuzuya ◽  
Takayoshi Morita ◽  
Atsushi Kumanogoh
Keyword(s):  
Mycophenolate Mofetil ◽  
Induction Therapy ◽  
Therapeutic Efficacy ◽  
Remission Rate ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Cochrane Library ◽  
Remission Induction ◽  
The Difference ◽  
Randomised Controlled

ObjectivesA few studies on antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) treatments have shown the therapeutic efficacy of mycophenolate mofetil (MMF). However, the therapeutic efficacy of MMF compared with that of cyclophosphamide (CYC) in patients with AAV has not been established. We conducted a systematic review and meta-analysis to assess the efficacy of MMF as a remission induction therapy in patients with AAV comparing it with the efficacy of CYC.MethodsWe searched randomised controlled trials (RCTs) comparing the efficacy of MMF with that of CYC in patients with AAV on three different websites: PubMed, Cochrane Library and Google Scholar. We compared the difference in the relative risk (RR) of each outcome based on a Mantel-Haenszel random-effects model.ResultsWe analysed data from four RCTs with 300 patients for the study. The 6-month remission rate (RR 1.09, 95% CI 0.86 to 1.38, p=0.48), the 6-month ANCA negativity (RR 1.31, 95% CI 0.91 to 1.90, p=0.15) and the long-term relapse rate (RR 1.36, 95% CI 0.80 to 2.31, p=0.26) were all similar between the two treatments. The rates of death, infection and leucopenia were also similar between the two groups (RR 1.05, 95% CI 0.40 to 2.74, p=0.93; RR 1.26, 95% CI 0.79 to 2.01, p=0.33; RR 0.45, 95% CI 0.16 to 1.32, p=0.15, respectively).ConclusionsWe found no difference between the therapeutic efficacy of MMF and that of CYC in patients with AAV. MMF may be an alternative remission induction therapy in patients with non-life-threatening AAV.

scholarly journals Efficacy of plasma exchange for antineutrophil cytoplasmic antibody-associated systemic vasculitis: a systematic review and meta-analysis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Yosuke Yamada ◽  
Makoto Harada ◽  
Yuuta Hara ◽  
Ryohei Iwabuchi ◽  
Koji Hashimoto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plasma Exchange ◽  
Granulomatosis With Polyangiitis ◽  
Disease Incidence ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
World Health ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Link Type ◽  
Pulse Steroid

Abstract Objective To assess through systematic review and meta-analysis whether plasma exchange (PE) is associated with prognosis in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. Methods A systematic search of PubMed, MEDLINE, Embase, and CENTRAL databases from inception to 17 June 2020 was conducted. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. Randomised controlled trials (RCTs) comparing PE vs. non-PE in AAV patients (microscopic polyangiitis [MPA], granulomatosis with polyangiitis [GPA], or eosinophilic granulomatosis with polyangiitis [EGPA]) were included. The combined risk ratio (RR) was calculated by the random-effects model using the Mantel-Haenszel method. Heterogeneity was measured using the I2 statistic. Primary outcomes were mortality, clinical remission (CR), and adverse events (AEs). Results Four RCTs comparing PE vs. no PE (N = 827) and 1 RCT comparing PE vs. pulse steroid treatment (N = 137) were included. All participants were MPA or GPA patients (no EGPA patients). PE was not associated with main primary outcomes compared with no PE (mortality RR 0.93 [95% confidence interval {CI} 0.70–1.24], I2 = 0%; CR RR 1.02 [95% CI 0.91–1.15], I2 = 0%; and AE RR 1.10 [95% CI 0.73–1.68], I2 = 37%) or pulse steroid (mortality RR 0.99 [95% CI 0.71–1.37]; CR [the Birmingham Vasculitis Activity score] mean difference − 0.53 [95% CI − 1.40–0.34]; and AE RR 1.05 [95% CI 0.74–1.48]). Focusing on the early treatment phases, PE was associated with a reduction in end-stage renal disease incidence compared with both no PE (PE 1/43 vs. no PE 10/41; RR 0.14 [0.03–0.77] at 3 months) and pulse steroid (PE 11/70 vs. pulse steroid 23/67; RR 0.46 [0.24–0.86] at 3 months). Conclusion We carried out a systematic review and meta-analysis targeting all AAV patients, including MPA, GPA, and EGPA. In AAV patients, performing PE was not associated with the risk of mortality, CR, and AE. No RCT exists evaluating the efficacy of PE for EGPA; hence, this is required in the future. The results may affect the development of guidelines for AAV and may indicate the direction of future clinical research on AAV. Trial registration UMIN R000045239, PROSPERO CRD42020182566.

scholarly journals FRI0190 COMPARATIVE EFFICACY AND SAFETY OF MYCOPHENOLATE MOFETIL VERSUS CYCLOPHOSPHAMIDE IN PATIENTS WITH ACTIVE ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS: A META-ANALYSIS OF RANDOMIZED TRIALS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 678.2-678
Author(s):  
Y. H. Lee ◽  
G. G. Song
Keyword(s):  
Mycophenolate Mofetil ◽  
Infection Rate ◽  
Relapse Rate ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Remission Induction ◽  
Efficacy And Safety ◽  
Anca Associated Vasculitis ◽  
Significant Difference ◽  
Regression Test

Background:Cyclophosphamide (CYC) is effective for induction of remission of AAV, resulting in complete remission rates of around 70%. Thus, CYC has been the standard remission induction therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV); however, it is toxic and causes infections, malignancies, and infertility. Therefore, other agents that are less toxic but that have similar efficacy were explored. Since the disease course of AAV usually requires long-term immunosuppression, mycophenolate mofetil (MMF), a less toxic agent compared to CYC, has been explored as an alternative to CYC.Objectives:The aim of this study is to assess the efficacy and safety of MMF versus cyclophosphamide CYC in patients with active AAV.Methods:We performed a meta-analysis of four randomized clinical trials (RCTs) (300 patients) to examine the relative efficacy and safety of MMF compared to CYC in patients with active AAV.Results:There was no significant difference in remission at 6 months between MMF and CYC (OR 1.311, 95% confidence interval [CI] 0.570 – 3.017,P= 0.524). Additionally, the relapse rate did not differ between the MMF group and CYC group (OR 1.331, 95% CI 0.497 – 3.568,P= 0.570). There was no significant difference in serious adverse event (SAE) (OR 1.232, 95% CI 0.754 – 2.014,P= 0.404) and infection rate (OR 0.958, 95% CI 0.561 – 1.634,P= 0.873) between the MMF and CYC groups. Some heterogeneity was found in the meta-analysis of remission and relapse rate (I2= 57.4%, 63.4%), but no between-study heterogeneity was found during the meta-analysis of the SAE and infection rate. Egger’s regression test showed no evidence of publication bias (Egger’s regression testP-values > 0.1).Conclusion:MMF was an equally effective alternative treatment to CYC, and MMF was comparable to CYC in patients with active AAV in terms of safety, suggesting that MMF can be used as an alternative to CYC for remission induction in AAV.References:[1]Han F, Liu G, Zhang X, Li X, He Q, He X, Li Q, Wang S, Wang H, Chen J (2011) Effects of mycophenolate mofetil combined with corticosteroids for induction therapy of microscopic polyangiitis. Am J Nephrol 33:185-192[2]Jones RB, Hiemstra TF, Ballarin J et al (2019) Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis: a randomised, non-inferiority trial. Ann Rheum Dis 78:399-405[3]Tuin J, Stassen PM, Bogdan DI, Broekroelofs J, van Paassen P, Cohen Tervaert JW, Sanders JS, Stegeman CA (2019) Mycophenolate Mofetil Versus Cyclophosphamide for the Induction of Remission in Nonlife-Threatening Relapses of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Randomized, Controlled Trial. Clin J Am Soc Nephrol 14:1021-1028[4]Hu W, Liu C, Xie H, Chen H, Liu Z, Li L (2008) Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant 23:1307-1312Disclosure of Interests:None declared

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