Abstract: SA-PO662
Harmful Effects of Cyclophosphamide on Japanese Patients with Renal Vasculitis Associated with Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Positive Microscopic Polyangiitis
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Nakaya, Izaya, Iwate Prefectural Central Hospital, Morioka, Iwate-ken, Japan
- Morooka, Mizuho, Iwate Prefectural Central Hospital, Morioka, Iwate-ken, Japan
- Takahashi, Kei, Iwate Prefectural Central Hospital, Morioka, Iwate-ken, Japan
- Tsuchiya, Yoshinori, JCHO Sendai Hospital, Sendai, Miyagi-ken, Japan
- Iwabuchi, Masashi, JCHO Sendai Hospital, Sendai, Miyagi-ken, Japan
- Soma, Jun, Iwate Prefectural Central Hospital, Morioka, Iwate-ken, Japan
Background
In Europe, combination of glucocorticoid (GC) and cyclophosphamide (CY) or rituximab is recommended as an induction therapy in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. However, many Japanese patients with myeloperoxidase (MPO)-ANCA-positive microscopic polyangiitis (MPA) are treated with only GC.
Methods
We retrospectively reviewed patients with newly diagnosed MPO-ANCA-positive MPA in two Japanese institutes between April 2000 and March 2017. Patients with serum creatinine levels > 5.0 mg/dL or those <20 years of age were excluded. Patients were divided into two groups based on whether they received combination therapy of GC plus CY (CY group), therapy with only GC, or GC plus other therapies excepting CY for remission induction (non-CY group). Primary endpoint was a combination of death and end-stage renal disease (ESRD). Pairwise 1:2 propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics.
Results
Among 121 eligible patients, 27 [17 men (63.0%), average age 66.9 ± 10.2 (mean ± SD) years] were assigned to the CY group, whereas 54 [32 men (59.3%), average age 67.0 ± 14.7 years] were assigned to the non-CY group. Both groups had similar propensity scores. In the CY group, 22 patients were treated with oral CY and five with intravenous CY. In the non-CY group, 42 patients were treated with GC alone and 12 with a combination of GC and other therapeutics, including intravenous immunoglobulin, mizoribine, and lymphocyte apheresis. No patient was treated with rituximab. Fifteen primary endpoints (8 deaths and 7 ESRDs) occurred in the CY group, whereas 14 (10 deaths and 4 ESRDs) occurred in the non-CY group. The 1- and 5-year survival rates were 0.89 and 0.60 in the CY group and 0.93 and 0.79 in the non-CY group (p = 0.039), respectively. Hazard ratio in the CY group was 2.14 (95% confidential interval, 1.02–4.52) as compared with the non-CY group.
Conclusion
Induction therapy with CY increased the risk of death and ESRD by 114% as compared with therapy without CY in Japanese patients with renal vasculitis associated with MPO-ANCA-positive MPA. Therefore, CY should not be used for induction therapy in these patients.