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ID 60860
フルテキストURL
著者
Sada, Ken-Ei Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Ohashi, Keiji Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Asano, Yosuke Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Hayashi, Keigo Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Morishita, Michiko Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Watanabe, Haruki Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Matsumoto, Yoshinori Department of Clinical Epidemiology, Kochi Medical School, Kochi University
Fujimoto, Shouichi Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
Takasaki, Yoshinari Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine
Yamagata, Kunihiro Department of Nephrology, Faculty of Medicine, University of Tsukuba
Banno, Shogo Department of Nephrology and Rheumatology, Aichi Medical University
Dobashi, Hiroaki Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University
Amano, Koichi Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
Harigai, Masayoshi Department of Rheumatology, Tokyo Women’s Medical University School of Medicine
Arimura, Yoshihiro Department of Nephrology and Rheumatology, Kyorin University School of Medicine
Makino, Hirofumi Okayama University ORCID Kaken ID publons researchmap
the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis (JPVAS) and the Research Committee of Intractable Renal Disease of the Ministry of Health, Labour, and Welfare of Japan
抄録
Background
It is not elucidated that there is treatment-related damage in elderly patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV).
Methods
Elderly (≥ 75 years of age) patients were enrolled from two nationwide prospective inception cohort studies. The primary outcome was 12-month treatment-related Vasculitis Damage Index (VDI) score. Secondary outcomes included serious infections within 6 months, total VDI score, remission, and relapse. Patient characteristics and outcomes were compared across three different initial glucocorticoid (GC) dose groups: high-dose, prednisolone (PSL) ≥ 0.8 mg/kg/day; medium-dose, 0.6 ≤ PSL < 0.8 mg/kg/day; and low-dose, PSL < 0.6 mg/kg/day.
Results
Of the 179 eligible patients, the mean age was 80.0 years; 111 (62%) were female. The mean Birmingham Vasculitis Activity Score was 16.1. Myeloperoxidase-ANCA findings were positive in 168 (94%) patients, while proteinase 3-ANCA findings were positive in 11 (6%). The low-dose group was older and had higher serum creatinine levels than the other groups. There were no statistically significant intergroup differences in remission or relapse, whereas serious infection developed more frequently in the high-dose (29 patients [43%]) than the low-dose (13 patients [22%]) or medium-dose (10 patients [19%]) groups (p = 0.0007). Frequent VDI items at 12 months included hypertension (19%), diabetes (13%), atrophy and weakness (13%), osteoporosis (8%), and cataracts (8%). Logistic regression analysis revealed that GC dose at 12 months (odds ratio, 1.14; 95% confidence interval, 1.00–1.35) was a predictor for diabetes.
Conclusion
A reduced initial GC dose with rapid reduction might be required to ensure the safe treatment of elderly AAV patients.
キーワード
ANCA-associated vasculitis
Chronic damage
Elderly patients
Glucocorticoids
発行日
2020-10-12
出版物タイトル
Arthritis Research & Therapy
22巻
1号
出版者
BMC
開始ページ
236
ISSN
1478-6354
NCID
AA11830978
資料タイプ
学術雑誌論文
言語
English
OAI-PMH Set
岡山大学
著作権者
© The Author(s). 2020
論文のバージョン
publisher
PubMed ID
DOI
Web of Science KeyUT
関連URL
isVersionOf https://doi.org/10.1186/s13075-020-02341-6
ライセンス
http://creativecommons.org/licenses/by/4.0/
助成機関名
文部科学省
Japan Agency for Medical Research and Development
助成番号
nannti-ippann-004
nannti-ippann-018
JP17ek0109104
JP17ek0109121
JP18ek0109360