Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse

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Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse. / Morgan, Matthew David; Szeto, Matthew; Walsh, Michael; Jayne, David; Westman, Kerstin; Rasmussen, Niels; Hiemstra, Thomas F; Flossmann, Oliver; Berden, Annelies; Höglund, Peter; Harper, Lorraine; European Vasculitis Society (EUVAS).

In: Arthritis Research & Therapy, Vol. 19, No. 1, 07.06.2017, p. 129.

Research output: Contribution to journalArticlepeer-review

Harvard

Morgan, MD, Szeto, M, Walsh, M, Jayne, D, Westman, K, Rasmussen, N, Hiemstra, TF, Flossmann, O, Berden, A, Höglund, P, Harper, L & European Vasculitis Society (EUVAS) 2017, 'Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse', Arthritis Research & Therapy, vol. 19, no. 1, pp. 129. https://doi.org/10.1186/s13075-017-1321-1, https://doi.org/10.1186/s13075-017-1321-1

APA

Morgan, M. D., Szeto, M., Walsh, M., Jayne, D., Westman, K., Rasmussen, N., Hiemstra, T. F., Flossmann, O., Berden, A., Höglund, P., Harper, L., & European Vasculitis Society (EUVAS) (2017). Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse. Arthritis Research & Therapy, 19(1), 129. https://doi.org/10.1186/s13075-017-1321-1, https://doi.org/10.1186/s13075-017-1321-1

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Author

Morgan, Matthew David ; Szeto, Matthew ; Walsh, Michael ; Jayne, David ; Westman, Kerstin ; Rasmussen, Niels ; Hiemstra, Thomas F ; Flossmann, Oliver ; Berden, Annelies ; Höglund, Peter ; Harper, Lorraine ; European Vasculitis Society (EUVAS). / Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse. In: Arthritis Research & Therapy. 2017 ; Vol. 19, No. 1. pp. 129.

Bibtex

@article{ee878e2f812f434497d336ce302167de,
title = "Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse",
abstract = "BACKGROUND: Relapse of disease is frequent in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). It is unclear whether persistent ANCA when starting maintenance therapy increases the risk of relapse. We examined the association between ANCA status and relapse in two randomised controlled trials.METHODS: ANCA-positive patients in two trials, CYCLOPS and IMPROVE, were switched from cyclophosphamide to maintenance therapy after achieving clinical remission. We classified patients as being either ANCA-positive or ANCA-negative at the time they started maintenance therapy. We compared the risk of relapse in ANCA-positive and ANCA-negative patients.RESULTS: Of 252 patients included, 102 (40%) experienced at least one relapse during the follow-up period. At the time of the switch from induction to maintenance therapy, 111 were ANCA-positive, of whom 55 (50%) relapsed, compared to 141 patients who were ANCA-negative, of whom 47 (33%) relapsed. In multivariable time-to-event analysis, a reduced risk of relapse was associated with having become ANCA-negative at the time of switching to maintenance therapy (hazard ratio 0.63, 95% confidence interval 0.42-0.95; p = 0.026). In addition, initial proteinase 3 (PR3)-ANCA, younger age, lower serum creatinine, pulsed cyclophosphamide for remission induction, and mycophenolate mofetil for remission maintenance were all associated with an increased risk of relapse.CONCLUSIONS: Becoming ANCA-negative before the switch to maintenance is associated with a reduced risk of relapse.TRIAL REGISTRATION: CYCLOPS: ClinicalTrials.gov, NCT00430105 . Registered retrospectively on 31 January 2007.IMPROVE: ClinicalTrials.gov, NCT00307645 . Registered retrospectively on 27 March 2006.",
keywords = "Journal Article",
author = "Morgan, {Matthew David} and Matthew Szeto and Michael Walsh and David Jayne and Kerstin Westman and Niels Rasmussen and Hiemstra, {Thomas F} and Oliver Flossmann and Annelies Berden and Peter H{\"o}glund and Lorraine Harper and {European Vasculitis Society (EUVAS)}",
year = "2017",
month = jun,
day = "7",
doi = "10.1186/s13075-017-1321-1",
language = "English",
volume = "19",
pages = "129",
journal = "Arthritis Research & Therapy",
issn = "1478-6354",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Negative anti-neutrophil cytoplasm antibody at switch to maintenance therapy is associated with a reduced risk of relapse

AU - Morgan, Matthew David

AU - Szeto, Matthew

AU - Walsh, Michael

AU - Jayne, David

AU - Westman, Kerstin

AU - Rasmussen, Niels

AU - Hiemstra, Thomas F

AU - Flossmann, Oliver

AU - Berden, Annelies

AU - Höglund, Peter

AU - Harper, Lorraine

AU - European Vasculitis Society (EUVAS)

PY - 2017/6/7

Y1 - 2017/6/7

N2 - BACKGROUND: Relapse of disease is frequent in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). It is unclear whether persistent ANCA when starting maintenance therapy increases the risk of relapse. We examined the association between ANCA status and relapse in two randomised controlled trials.METHODS: ANCA-positive patients in two trials, CYCLOPS and IMPROVE, were switched from cyclophosphamide to maintenance therapy after achieving clinical remission. We classified patients as being either ANCA-positive or ANCA-negative at the time they started maintenance therapy. We compared the risk of relapse in ANCA-positive and ANCA-negative patients.RESULTS: Of 252 patients included, 102 (40%) experienced at least one relapse during the follow-up period. At the time of the switch from induction to maintenance therapy, 111 were ANCA-positive, of whom 55 (50%) relapsed, compared to 141 patients who were ANCA-negative, of whom 47 (33%) relapsed. In multivariable time-to-event analysis, a reduced risk of relapse was associated with having become ANCA-negative at the time of switching to maintenance therapy (hazard ratio 0.63, 95% confidence interval 0.42-0.95; p = 0.026). In addition, initial proteinase 3 (PR3)-ANCA, younger age, lower serum creatinine, pulsed cyclophosphamide for remission induction, and mycophenolate mofetil for remission maintenance were all associated with an increased risk of relapse.CONCLUSIONS: Becoming ANCA-negative before the switch to maintenance is associated with a reduced risk of relapse.TRIAL REGISTRATION: CYCLOPS: ClinicalTrials.gov, NCT00430105 . Registered retrospectively on 31 January 2007.IMPROVE: ClinicalTrials.gov, NCT00307645 . Registered retrospectively on 27 March 2006.

AB - BACKGROUND: Relapse of disease is frequent in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). It is unclear whether persistent ANCA when starting maintenance therapy increases the risk of relapse. We examined the association between ANCA status and relapse in two randomised controlled trials.METHODS: ANCA-positive patients in two trials, CYCLOPS and IMPROVE, were switched from cyclophosphamide to maintenance therapy after achieving clinical remission. We classified patients as being either ANCA-positive or ANCA-negative at the time they started maintenance therapy. We compared the risk of relapse in ANCA-positive and ANCA-negative patients.RESULTS: Of 252 patients included, 102 (40%) experienced at least one relapse during the follow-up period. At the time of the switch from induction to maintenance therapy, 111 were ANCA-positive, of whom 55 (50%) relapsed, compared to 141 patients who were ANCA-negative, of whom 47 (33%) relapsed. In multivariable time-to-event analysis, a reduced risk of relapse was associated with having become ANCA-negative at the time of switching to maintenance therapy (hazard ratio 0.63, 95% confidence interval 0.42-0.95; p = 0.026). In addition, initial proteinase 3 (PR3)-ANCA, younger age, lower serum creatinine, pulsed cyclophosphamide for remission induction, and mycophenolate mofetil for remission maintenance were all associated with an increased risk of relapse.CONCLUSIONS: Becoming ANCA-negative before the switch to maintenance is associated with a reduced risk of relapse.TRIAL REGISTRATION: CYCLOPS: ClinicalTrials.gov, NCT00430105 . Registered retrospectively on 31 January 2007.IMPROVE: ClinicalTrials.gov, NCT00307645 . Registered retrospectively on 27 March 2006.

KW - Journal Article

U2 - 10.1186/s13075-017-1321-1

DO - 10.1186/s13075-017-1321-1

M3 - Article

C2 - 28592297

VL - 19

SP - 129

JO - Arthritis Research & Therapy

JF - Arthritis Research & Therapy

SN - 1478-6354

IS - 1

ER -