title: Effects of cyclophosphamide on the prognosis of Japanese patients with renal vasculitis associated with anti-neutrophil cytoplasmic antibody-positive microscopic polyangiitis.
abstract: BACKGROUND
  The aim of this study was to determine the efficacy of cyclophosphamide (CY) on anti-neutrophil cytoplasmic antibody (ANCA)-positive microscopic polyangiitis (MPA) with renal involvement in Japanese patients.
  
  
  METHODS
  Eighty-two patients with newly diagnosed ANCA-positive MPA were enrolled in this retrospective study. Patients were divided into two groups based on whether they received combination therapy with a corticosteroid (CS) plus CY (CY group) or CS alone or with other therapies (non-CY group). The primary outcome was defined as the combination of death and end-stage renal disease (ESRD).
  
  
  RESULTS
  The CY and non-CY groups included 29 and 53 patients, respectively. In the non-CY group, 31 patients were treated with CS alone, and 22 with a combination of CS and other therapeutics. The percentage of males and mean Birmingham vasculitis activity scores were higher in the CY group than those in the non-CY group, but other factors such as age, serum creatinine, serum albumin, or CRP at baseline were equivalent in the two groups. No differences were observed in remission rates using induction therapy for the two groups. However, the survival rate 5 years after induction therapy was lower in the CY group than in the non-CY group (0.50 vs. 0.73; P = 0.041), although the hazard ratio of CY for the primary outcome adjusted for all confounding factors was 1.321 [95 % confidence interval (CI), 0.662-2.637; P = 0.171].
  
  
  CONCLUSIONS
  CY may not have an additive effect on induction therapy with CS for Japanese patients with renal vasculitis associated with ANCA-positive MPA.
authors.affiliation: Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.affiliation: Department of Nephrology, Iwate Prefectural Central Hospital, Ueda 1-4-1, Morioka, 020-0066, Japan. inakaya@chuo-hp.jp.
authors.forename: Izaya
authors.initials: I
authors.lastname: Nakaya
authors.affiliation: Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tsuchiya
authors.affiliation: Division of Nephrology and Hypertension, St. Marianna University School of Medical Hospital, Kawasaki, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.affiliation: Department of Biostatistics, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oe
authors.affiliation: Department of Pathology, Iwate Prefectural Central Hospital, Morioka, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakuma
authors.affiliation: Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taguma
authors.affiliation: Department of Nephrology, Iwate Prefectural Central Hospital, Ueda 1-4-1, Morioka, 020-0066, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Soma
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D008297:Male; D055953:Microscopic Polyangiitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Anti-neutrophil cytoplasmic antibody; Cyclophosphamide; Microscopic polyangiitis; Remission induction; Renal vasculitis