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
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
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日本厚生劳动省难治性血管炎研究委员会 2023 年临床实践指南对 ANCA 相关血管炎管理的系统回顾和荟萃分析
DOI：
10.1093/mr/roac114
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发表时间：
2022
影响因子：
2.2
通讯作者：
Tamura N
中科院分区：
文献类型：
--
作者：
Watanabe Ryu;Oshima Megumi;Nishioka Norihiro;Sada Ken-Ei;Nagasaka Kenji;Akiyama Mitsuhiro;Ando Taiki;Higuchi Tomoaki;Inoue Yoshino;Kida Takashi;Mutoh Tomoyuki;Nakabayashi Akihiko;Onishi Akira;Sakai Ryota;Waki Daisuke;Yamada Yosuke;Yajima Nobuyuki;Tamura N
目的本研究的目的是为日本难治性血管炎研究委员会修订抗中性粒细胞胞浆抗体（ANCA）相关性血管炎临床实践指南提供证据。方法检索 PubMed、CENTRAL 和日本医学文摘协会数据库中 2015 年至 2020 年间发表的文章，以更新现有临床问题的系统评价，同时 PubMed、 检索了 CENTRAL、EMBASE 和日本医学文摘学会 2000 年至 2020 年间发表的文章，对新开发的临床问题进行系统评价。采用 GRADE 方法评估证据的确定性。结果对于诱导缓解，当与环磷酰胺或利妥昔单抗联合使用时，与标准剂量糖皮质激素相比，减少剂量的糖皮质激素可降低严重不良事件的风险。与高剂量糖皮质激素相比，Avacopan 改善了 12 个月的持续缓解。在缓解诱导治疗中添加血浆置换并不能降低死亡、终末期肾病或复发的风险。对于维持缓解，与硫唑嘌呤相比，利妥昔单抗降低了复发风险。与短期利妥昔单抗或硫唑嘌呤相比，长期利妥昔单抗或硫唑嘌呤分别降低了复发风险。结论本系统评价为制定 2023 年 ANCA 相关血管炎治疗临床实践指南提供了所需的证据。
ObjectivesThe 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.MethodsPubMed, 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.ResultsFor 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.ConclusionsThis systematic review provided evidence required to develop the 2023 clinical practice guideline for the management of ANCA-associated vasculitis.