Systematic review and meta-analysis for 2017 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.

Abstract:

OBJECTIVES:To provide evidence for the revision of clinical practice guideline (CPG) for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) by the Japan Research Committee for Intractable Vasculitis. METHODS:PubMed, CENTRAL, and the Japan Medical Abstracts Society were searched for articles published between January 1994 and January 2015 to conduct systematic review (SR), and the quality of evidence was assessed with GRADE approach. RESULTS:Nine randomized controlled trials (RCTs) and two non-RCTs were adopted for remission induction therapy, three RCTs and two non-RCTs for plasma exchange, and five RCTs and one non-RCT for remission maintenance therapy. A significant difference was found in efficacy and safety for the following comparisons. In the non-RCT adopted for remission induction therapy, glucocorticoid (GC) + cyclophosphamide (CY) was significantly superior to GC monotherapy regarding remission. GC + intravenous CY for remission induction therapy was superior to GC + oral CY regarding death at one year, serious adverse events, and serious infection. Concomitant use of plasma exchange for remission induction therapy of AAV with severe renal dysfunction reduced risk of end-stage renal disease versus non-users at month 3. CONCLUSION:This SR provided necessary evidence for developing CPG for the management of ANCA-associated vasculitis.

journal_name

Mod Rheumatol

journal_title

Modern rheumatology

authors

Nagasaka K,Harigai M,Hagino N,Hara A,Horita T,Hayashi T,Itabashi M,Ito S,Katsumata Y,Kawashima S,Naniwa T,Sada KE,Nango E,Nakayama T,Tsutsumino M,Yamagata K,Homma S,Arimura Y

doi

10.1080/14397595.2018.1500111

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

119-129

issue

1

eissn

1439-7595

issn

1439-7609

journal_volume

29

pub_type

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