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

Author:

Watanabe Ryu1,Oshima Megumi2,Nishioka Norihiro3,Sada Ken-Ei45,Nagasaka Kenji67,Akiyama Mitsuhiro8,Ando Taiki9,Higuchi Tomoaki10,Inoue Yoshino11,Kida Takashi12,Mutoh Tomoyuki1314,Nakabayashi Akihiko15,Onishi Akira16,Sakai Ryota17,Waki Daisuke18,Yamada Yosuke19,Yajima Nobuyuki20,Tamura Naoto9,Kaname Shinya21,Harigai Masayoshi22ORCID

Affiliation:

1. Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine , Osaka, Japan

2. Department of Nephrology and Laboratory Medicine, Kanazawa University , Kanazawa, Japan

3. Department of Preventive Services, Kyoto University School of Public Health , Kyoto, Japan

4. Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Okayama University , Okayama, Japan

5. Department of Clinical Epidemiology, Kochi Medical School, Kochi University , Nankoku, Japan

6. Department of Rheumatology, Ome Municipal General Hospital , Ome, Japan

7. Department of Rheumatology and Medicine, Tokyo Medical and Dental University (TMDU) , Tokyo, Japan

8. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine , Tokyo, Japan

9. Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine , Tokyo, Japan

10. Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women’s Medical University School of Medicine , Tokyo, Japan

11. First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health , Kitakyushu, Japan

12. Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan

13. Department of Rheumatology, Osaki Citizen Hospital , Osaki, Japan

14. Department of Rheumatology, Tohoku University Hospital , Sendai, Japan

15. Department of Rheumatology and Allergology, National Hospital Organization Osaka Minami Medical Center , Osaka, Japan

16. Department of Advanced Medicine for Rheumatic diseases, Graduate School of Medicine, Kyoto University , Kyoto, Japan

17. Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University , Kawagoe, Japan

18. Department of Endocrinology and Rheumatology, Kurashiki Central Hospital , Kurashiki, Japan

19. Department of Nephrology, Shinshu University School of Medicine , Nagano, Japan

20. Division of Rheumatology, Department of Medicine, Showa University School of Medicine , Tokyo, Japan

21. Department of Nephrology and Rheumatology, Kyorin University School of Medicine , Mitaka, Japan

22. Division of Rheumatology, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine , Tokyo, Japan

Abstract

ABSTRACT 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.

Funder

Ministry of Health, Labour, and Welfare of Japan

Publisher

Oxford University Press (OUP)

Subject

Rheumatology

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