Systematic review and meta-analysis for 2023 clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis for the management of ANCA-associated vasculitis

被引：9

作者：

Watanabe, Ryu ^{[1
]}

Oshima, Megumi ^{[2
]}

Nishioka, Norihiro ^{[3
]}

Sada, Ken-Ei ^{[4
,5
]}

Nagasaka, Kenji ^{[6
,7
]}

Akiyama, Mitsuhiro ^{[8
]}

Ando, Taiki ^{[9
]}

Higuchi, Tomoaki ^{[10
]}

Inoue, Yoshino ^{[11
]}

Kida, Takashi ^{[12
]}

Mutoh, Tomoyuki ^{[13
,14
]}

Nakabayashi, Akihiko ^{[15
]}

Onishi, Akira ^{[16
]}

Sakai, Ryota ^{[17
]}

Waki, Daisuke ^{[18
]}

Yamada, Yosuke ^{[19
]}

Yajima, Nobuyuki ^{[20
]}

Tamura, Naoto ^{[10
]}

Kaname, Shinya ^{[21
]}

Harigai, Masayoshi ^{[22
]}

机构：

[1] Osaka Metropolitan Univ, Dept Clin Immunol, Grad Sch Med, Osaka, Japan

[2] Kanazawa Univ, Dept Nephrol & Lab Med, Kanazawa, Ishikawa, Japan

[3] Kyoto Univ, Dept Prevent Serv, Sch Publ Hlth, Kyoto, Japan

[4] Okayama Univ, Grad Sch Med, Dept Nephrol Rheumatol, Okayama, Japan

[5] Kochi Univ, Kochi Med Sch, Dept Clin Epidemiol, Nankoku, Kochi, Japan

[6] Ome Municipal Gen Hosp, Dept Rheumatol, Ome, Japan

[7] Tokyo Med & Dent Univ TMDU, Dept Rheumatol & Med, Tokyo, Japan

[8] Keio Univ, Dept Internal Med, Div Rheumatol, Sch Med, Tokyo, Japan

[9] Juntendo Univ, Dept Internal Med & Rheumatol, Sch Med, Tokyo, Japan

[10] Tokyo Womens Med Univ, Div Multidisciplinary Management Rheumat Dis, Sch Med, Tokyo, Japan

[11] Univ Occupat & Environm Hlth, Sch Med, Dept Internal Med 1, Kitakyushu, Fukuoka, Japan

[12] Kyoto Prefectural Univ Med, Grad Sch Med Sci, Dept Inflammat & Immunol, Kyoto, Japan

[13] Osaki Citizen Hosp, Dept Rheumatol, Osaki, Japan

[14] Tohoku Univ Hosp, Dept Rheumatol, Sendai, Miyagi, Japan

[15] Natl Hosp Org, Dept Rheumatol & Allergol, Osaka Minami Med Ctr, Osaka, Japan

[16] Kyoto Univ, Grad Sch Med, Dept Adv Med Rheumat Dis, Kyoto, Japan

[17] Saitama Med Univ, Saitama Med Ctr, Dept Rheumatol & Clin Immunol, Kawagoe, Saitama, Japan

[18] Kurashiki Cent Hosp, Dept Endocrinol & Rheumatol, Kurashiki, Okayama, Japan

[19] Shinshu Univ, Dept Nephrol, Sch Med, Nagano, Japan

[20] Showa Univ, Dept Med, Div Rheumatol, Sch Med, Tokyo, Japan

[21] Kyorin Univ, Dept Nephrol & Rheumatol, Sch Med, Mitaka, Tokyo, Japan

[22] Tokyo Womens Med Univ, Dept Internal Med, Div Rheumatol, Sch Med, 8-1 Kawada cho,Shinjuku ku, Tokyo 1628666, Japan

来源：

MODERN RHEUMATOLOGY | 2023年 / 33卷 / 05期

关键词：

ANCA-associated vasculitis; GRADE system; granulomatosis with polyangiitis; microscopic polyangiitis; systematic review; RHEUMATOLOGY CLASSIFICATION CRITERIA; ANTIBODY-ASSOCIATED VASCULITIS; PLASMA-EXCHANGE; MAINTENANCE THERAPY; AMERICAN-COLLEGE; MYCOPHENOLATE-MOFETIL; RITUXIMAB; CYCLOPHOSPHAMIDE; AZATHIOPRINE; INDUCTION;

D O I：

10.1093/mr/roac114

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The objective of this study is to provide evidence for the revision of clinical practice guidelines for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis by the Japan Research Committee for Intractable Vasculitis. Methods PubMed, CENTRAL, and the Japan Medical Abstracts Society databases were searched for articles published between 2015 and 2020 to update the systematic review for existing clinical questions, while PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society were searched for articles published between 2000 and 2020 to conduct a systematic review for newly developed clinical questions. The certainty of evidence was assessed with the GRADE approach. Results For remission induction, when used in conjunction with cyclophosphamide or rituximab, reduced-dose glucocorticoid lowered the risk of serious adverse events compared to standard-dose glucocorticoid. Avacopan improved sustained remission at 12 months compared to high-dose glucocorticoid. Addition of plasma exchange to remission induction therapy did not reduce the risk of death, end-stage kidney disease, or relapse. For remission maintenance, rituximab reduced the risk of relapse compared to azathioprine. Long-term rituximab or azathioprine reduced the risk of relapse compared to short-term rituximab or azathioprine, respectively. Conclusions This systematic review provided evidence required to develop the 2023 clinical practice guideline for the management of ANCA-associated vasculitis.

引用

页码：982 / 989

页数：8

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