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2017 ; 69
(1
): 185-193
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Association of Serum Calprotectin (S100A8/A9) Level With Disease Relapse in
Proteinase 3-Antineutrophil Cytoplasmic Antibody-Associated Vasculitis
#MMPMID27428710
Pepper RJ
; Draibe JB
; Caplin B
; Fervenza FC
; Hoffman GS
; Kallenberg CG
; Langford CA
; Monach PA
; Seo P
; Spiera R
; William St Clair E
; Tchao NK
; Stone JH
; Specks U
; Merkel PA
; Salama AD
Arthritis Rheumatol
2017[Jan]; 69
(1
): 185-193
PMID27428710
show ga
OBJECTIVE: S100A8/A9 (calprotectin) has shown promise as a biomarker for
predicting relapse in antineutrophil cytoplasmic antibody (ANCA)-associated
vasculitis (AAV). This study was undertaken to investigate serum S100A8/A9 level
as a biomarker for predicting future relapse in a large cohort of patients with
severe AAV. METHODS: Serum levels of S100A8/A9 were measured at baseline and
months 1, 2, and 6 following treatment initiation in 144 patients in the
Rituximab in ANCA-Associated Vasculitis trial (cyclophosphamide/azathioprine
versus rituximab [RTX] for induction of remission) in whom complete remission was
attained. RESULTS: Patients were divided into 4 groups: proteinase 3 (PR3)-ANCA
with relapse (n?=?37), PR3-ANCA without relapse (n?=?56), myeloperoxidase
(MPO)-ANCA with relapse (n?=?6), and MPO-ANCA without relapse (n?=?45). Serum
S100A8/A9 level decreased in all groups during the first 6 months of treatment.
The percentage reduction from baseline to month 2 was significantly different
between patients who experienced a relapse and those who did not in the PR3-ANCA
group (P?=?0.046). A significantly higher risk of relapse was associated with an
increase in S100A8/A9 level between baseline and month 2 (P?=?0.0043) and
baseline and month 6 (P?=?0.0029). Subgroup analysis demonstrated that patients
treated with RTX who had increased levels of S100A8/A9 were at greatest risk of
future relapse (P?=?0.028). CONCLUSION: An increase in serum S100A8/A9 level by
month 2 or 6 compared to baseline identifies a subgroup of PR3-ANCA patients
treated with RTX who are at higher risk of relapse by 18 months. Since RTX is
increasingly used for remission induction in PR3-ANCA-positive patients
experiencing a relapse, S100A8/A9 level may assist in identifying those patients
requiring more intensive or prolonged treatment.