Association Between Bronchiectasis and Serious Infections in Microscopic Polyangiitis and Granulomatosis With Polyangiitis From the J-CANVAS.
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Omura Satoshi, Kida Takashi, Inoue Hironori, Shimada Yuki, Nakagomi Daiki, Abe Yoshiyuki, Takizawa Naoho, Nomura Atsushi, Kukida Yuji, Kondo Naoya, Takagi Hirosuke, Endo Koji, Hirata Shintaro, Azuma Naoto, Takeuchi Tohru, Fukui Shoichi, Kamada Kazuro, Yanai Ryo, Matsuo Yusuke, Shimojima Yasuhiro, Nishioka Ryo, Okazaki Ryota, Takata Tomoaki, Moriyama Mayuko, Takatani Ayuko, Miyawaki Yoshia, Shirai Tsuyoshi, Dobashi Hiroaki, Ito Takafumi, Matsumoto Isao, Takada Toshihiko, Ito-Ihara Toshiko, Yajima Nobuyuki, Kawaguchi Takashi, Seno Takahiro, Kohno Masataka, Wada Makoto, Kawahito Yutaka
Аннотация
METHODS: We conducted a multicenter observational study using data from the Japan Collaborative Registry of ANCA-Associated Vasculitis (J-CANVAS). Adult patients with newly diagnosed or relapsing MPA or GPA between January 2017 and March 2023 were included. The exposure was clinically apparent bronchiectasis at baseline. Primary outcomes were serious infections and all-cause mortality; relapses were examined as a secondary outcome over 52 weeks. For each outcome, incidence rate ratios (IRRs) were estimated using multivariable Poisson regression models conditioned on confounding factors, incorporating follow-up time as an offset term. Interactions between initial treatment (prednisone dose, rituximab, cyclophosphamide, intravenous methylprednisolone, and plasma exchange) and bronchiectasis were also evaluated.
RESULTS: Among 844 patients (MPA: 614; GPA: 230), 68 (8.1%) had bronchiectasis. During the follow-up period, there were 122 serious infections among 101 patients, 48 deaths, and 85 relapses among 72 patients. Adjusted IRRs for patients with bronchiectasis were 2.18 (95% CI: 1.25-3.83) for serious infections, 3.07 (1.41-6.66) for mortality, and 1.58 (0.77-3.24) for relapse. No clear interaction was detected between specific treatments and bronchiectasis.
CONCLUSIONS: Bronchiectasis was associated with increased risks of serious infections and mortality in patients with MPA and GPA. However, we did not detect clear interaction by initial treatment, suggesting that avoiding specific therapies may not be necessary.