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Objective <p>Relapse is a major concern in patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV). There are several reports on predictors of AAV relapse; however, reports on Japanese patients are limited. This study aimed to identify risk factors for relapse in Japanese patients with AAV.</p> Method <p>We retrospectively analyzed 200 patients who initiated treatment at our institution and were subsequently managed across affiliated facilities. Clinical and laboratory data were analyzed. The primary outcome was relapse, and Cox proportional hazards models were used to identify associated risk factors.</p> Results <p>The median age of AAV onset was 69&#xa0;years (interquartile ranges (IQR), 62–76&#xa0;years). There were 103 (51%), 59 (30%), and 18 (9%) patients classified as having microscopic polyangiitis, granulomatosis with polyangiitis, and eosinophilic granulomatosis with polyangiitis, respectively, and 20 (10%) patients were unclassified. For remission induction, 196 (98%) patients were treated with corticosteroids combined with immunosuppressants in 116 (58%) patients, and 180 patients achieved remission. During the median follow-up period of 42&#xa0;months (IQR, 17–95&#xa0;months), relapse occurred in 54 patients (30%). In multivariate analysis, positive serum proteinase 3 (PR3)-ANCA (hazard ratio [HR] 1.938, 95% confidence interval [CI] 1.040–3.613) and pre-existing diabetes mellitus (DM) (HR 3.082, 95% CI 1.554–6.110) were associated with relapse.</p> Conclusion <p>Pre-existing DM and positive serum PR3-ANCA levels may predict relapse in patients with AAV.</p> <p><Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec colname="c1" colnum="1" /> <colspec colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> <p><b>Key Points</b></p> <p>• <i>A history of diabetes mellitus and PR3-ANCA positivity may be risk factors for relapse in ANCA-associated vasculitis.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

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Pre-existing diabetes mellitus and PR3-ANCA positivity as predictors of relapse in ANCA-associated vasculitis: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年11月9日

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  • Akifumi Tabei,
  • Yoichi Takeuchi,
  • Toru Sakairi,
  • Yuko Ohishi,
  • Mitsuharu Watanabe,
  • Masao Nakasatomi,
  • Hiroko Hamatani,
  • Hidekazu Ikeuchi,
  • Yoriaki Kaneko,
  • Keiju Hiromura

摘要

Objective

Relapse is a major concern in patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV). There are several reports on predictors of AAV relapse; however, reports on Japanese patients are limited. This study aimed to identify risk factors for relapse in Japanese patients with AAV.

Method

We retrospectively analyzed 200 patients who initiated treatment at our institution and were subsequently managed across affiliated facilities. Clinical and laboratory data were analyzed. The primary outcome was relapse, and Cox proportional hazards models were used to identify associated risk factors.

Results

The median age of AAV onset was 69 years (interquartile ranges (IQR), 62–76 years). There were 103 (51%), 59 (30%), and 18 (9%) patients classified as having microscopic polyangiitis, granulomatosis with polyangiitis, and eosinophilic granulomatosis with polyangiitis, respectively, and 20 (10%) patients were unclassified. For remission induction, 196 (98%) patients were treated with corticosteroids combined with immunosuppressants in 116 (58%) patients, and 180 patients achieved remission. During the median follow-up period of 42 months (IQR, 17–95 months), relapse occurred in 54 patients (30%). In multivariate analysis, positive serum proteinase 3 (PR3)-ANCA (hazard ratio [HR] 1.938, 95% confidence interval [CI] 1.040–3.613) and pre-existing diabetes mellitus (DM) (HR 3.082, 95% CI 1.554–6.110) were associated with relapse.

Conclusion

Pre-existing DM and positive serum PR3-ANCA levels may predict relapse in patients with AAV.

Key Points

• A history of diabetes mellitus and PR3-ANCA positivity may be risk factors for relapse in ANCA-associated vasculitis.