Prevalence and risk factors of relapse in patients with ANCA-associated vasculitis receiving cyclophosphamide induction: a systematic review and meta-analysis of large observational studies
| العنوان: | Prevalence and risk factors of relapse in patients with ANCA-associated vasculitis receiving cyclophosphamide induction: a systematic review and meta-analysis of large observational studies |
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| المؤلفون: | Lijie He, Peng He, Xiu-Juan Tian, Chen Huang, Shiren Sun, Jin-Ping Hu |
| المصدر: | Rheumatology. 60:1067-1079 |
| بيانات النشر: | Oxford University Press (OUP), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | medicine.medical_specialty, business.industry, Hazard ratio, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Azathioprine, Cochrane Library, medicine.disease, Confidence interval, Rheumatology, Recurrence, Risk Factors, Internal medicine, Meta-analysis, Prevalence, Humans, Medicine, Pharmacology (medical), Risk factor, business, Granulomatosis with polyangiitis, Vasculitis, Cyclophosphamide, Immunosuppressive Agents, medicine.drug |
| الوصف: | BackgroundClinical relapses are common in patients with ANCA-associated vasculitis (AAV). The aim of this systematic review was to estimate time-point prevalence and risk factors of relapse.MethodsWe searched PubMed, Embase, and Cochrane Library databases from their inception to March 30, 2020. Cohorts and post-hoc studies were included for the estimation of summary cumulative relapse rates (CRRs) and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Sensitivity and meta-regression analyses were also performed.ResultsOf the 42 eligible studies, 24 studies with 6236 participants were used for the pooled analyses of CRRs. The summary 1-year, 3-year, and 5-year CRRs were 0.12 (95% CI, 0.10–0.14), 0.33 (0.29–0.38), and 0.47 (0.42–0.52), respectively. In meta-regressions, the baseline age was positively associated with 1-year CRR. The proportion of granulomatosis with polyangiitis was positively associated with 5-year CRR. Twenty-eight studies with 5390 participants were used for the meta-analysis of risk factors for relapse, including a lower level of baseline serum creatine, proteinase 3 (PR3)-ANCA positivity at diagnosis, an ANCA rise, extrarenal organ involvement (including lung, cardiovascular, upper respiratory, and gastrointestinal involvement), intravenous (vs oral) cyclophosphamide induction, a shorter course of immunosuppressant maintenance, and maintenance with mycophenolate mofetil (vs azathioprine).ConclusionsOur systematic review demonstrated that the 1-year, 3-year, and 5-year cumulative probabilities of relapse were ∼12%, 33%, and 47% in AAV patients receiving cyclophosphamide induction, respectively. Early identification of risk factors for relapse is helpful to the risk stratification of patients so as to achieve personalized treatment. |
| تدمد: | 1462-0332 1462-0324 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::04f767ce9336c70219560be1c31bf64d https://doi.org/10.1093/rheumatology/keaa667 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....04f767ce9336c70219560be1c31bf64d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14620332 14620324 |
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