Diabetes mellitus and cardiac disease as key predictors of rituximab-induced acute thrombocytopenia in ANCA-associated vasculitis.
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Akao Satoshi, Shimizu Masaru, Maruo Kazushi, Asashima Hiromitsu, Kondo Yuya, Ohyama Ayako, Abe Saori, Kitada Ayako, Miki Haruka, Tsuboi Hiroto, Omura Satoshi, Nakagomi Daiki, Abe Yoshiyuki, Wada Makoto, 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, Takada Toshihiko, Kawahito Yutaka, Ito-Ihara Toshiko, Kida Takashi, Yajima Nobuyuki, Kawaguchi Takashi, Matsumoto Isao
Аннотация
METHODS: Patients with new-onset microscopic polyangiitis or granulomatosis with polyangiitis who received RTX in a nationwide multicentre registry in Japan were included. RIAT was defined by platelet count reductions within 28 days post-RTX. Risk factors for RIAT were identified by using logistic regression with stepwise selection, and prediction models were developed. Model performance was assessed using C-statistics.
RESULTS: Among 175 patients with AAV receiving RTX, RIAT occurred in 35.4% of them. Diabetes mellitus (odds ratio [OR] = 4.96), cardiac disease (OR = 3.57), low platelet count (OR = 1.04 per 104/μl decrease), increased serum creatinine (OR = 1.44 per 1 mg/dl increase), low albumin (OR = 2.33 per 1 g/dl decrease), and high KL-6 (OR = 1.09 per 100 U/ml increase) were identified as significant predictors. A predictive model incorporating these factors achieved a C-statistic of 0.817.
CONCLUSION: RIAT is a frequent complication of RTX induction in patients with AAV, with diabetes mellitus and cardiac disease being strong risk factors. Our predictive model enables risk assessment for RIAT, allowing clinicians to optimize treatment strategies.