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Optimal dose of intravenous cyclophosphamide during remission induction therapy in ANCA-associated vasculitis: A retrospective cohort study of J-CANVAS.
- Source :
-
Modern rheumatology [Mod Rheumatol] 2024 Jul 06; Vol. 34 (4), pp. 767-774. - Publication Year :
- 2024
-
Abstract
- Objectives: To identify the optimal dose of intravenous cyclophosphamide (IVCY) for induction therapy for anti-neutrophil cytoplasmic antibody-associated vasculitis.<br />Methods: We retrospectively assessed patients with antibody-associated vasculitis who received IVCY every 2-3 weeks during the remission induction phase. The associations of the IVCY dose with infection-free survival and relapse-free survival were analysed using a Cox regression model. We compared patients in three categories: very low-dose (VLD), low-dose (LD), and conventional dose (CD) (<7.5 mg/kg, 7.5-12.5 mg/kg, and >12.5 mg/kg, respectively). The non-linear association between IVCY dose and the outcomes was also evaluated.<br />Results: Of the 80 patients (median age 72 years), 12, 42, and 26 underwent the VLD, LD, and CD regimens, respectively, of whom 4, 3, and 7 developed infection or died. The adjusted hazard ratios for infection or death were 4.3 (95% confidence interval (CI) 0.94-19.8) for VLD and 5.1 (95% CI 1.21-21.3) for CD, compared with LD. We found the hazard ratio for infection or death increased when the initial IVCY dose exceeded 9 mg/kg. Relapse-free survival did not differ clearly.<br />Conclusion: Low-dose IVCY (7.5-12.5 mg/kg) may result in fewer infections and similar relapse rates compared with the conventional regimen (>12.5 mg/kg).<br /> (© Japan College of Rheumatology 2024. Published by Oxford University Press.)
- Subjects :
- Humans
Retrospective Studies
Female
Male
Aged
Middle Aged
Administration, Intravenous
Treatment Outcome
Aged, 80 and over
Dose-Response Relationship, Drug
Cyclophosphamide therapeutic use
Cyclophosphamide administration & dosage
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis mortality
Remission Induction
Immunosuppressive Agents therapeutic use
Immunosuppressive Agents administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1439-7609
- Volume :
- 34
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Modern rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 37801552
- Full Text :
- https://doi.org/10.1093/mr/road099