Predictors of Glucocorticoid-Free Clinical Remission at Week 48 in Newly Diagnosed Microscopic Polyangiitis and Granulomatosis with Polyangiitis: from nation-wide registry in Japan (J-CANVAS)

Yusuke Ushio¹, Satoshi Omura², Daiki Nakagomi³, Yoshiyuki Abe⁴, Makoto Wada⁵, Naoho Takizawa⁶, Atsushi Nomura⁷, Yuji Kukida⁸, Naoya Kondo⁹, Hirosuke Takagi¹⁰, Koji Endo¹¹, Shintaro Hirata¹², Naoto Azuma¹³, Tohru Takeuchi¹⁴, Shoichi Fukui¹⁵, Kazuro Kamada¹⁶, Ryo Yanai¹⁷, Yusuke Matsuo¹⁸, Yasuhiro Shimojima¹⁹, Ryo Nishioka²⁰, Ryota Okazaki²¹, Tomoaki Takata²², Mayuko Moriyama²³, Ayuko Takatani²⁴, Yoshia Miyawaki²⁵, Tsuyoshi Shirai²⁶, Takafumi Ito²⁷, Isao Matsumoto²⁸, Toshihiko Takada²⁹, Toshiko Ito-Ihara³⁰, Takashi Kida³¹, Nobuyuki Yajima¹⁷, Takashi Kawaguchi³², Yutaka Kawahito³¹ and Hiroaki Dobashi³³, ¹Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Miki-cho, Kita District, Kagawa, Japan, ²Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, ⁴⁶⁵, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan, ³Department of Rheumatology, University of Yamanashi Hospital, Chuo-shi, Yamanashi, Japan, ⁴Department of Internal Medicine and Rheumatology, Juntendo University, Bunkyo-Ku, Tokyo, Japan, ⁵Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto-shi, Kyoto, Japan, ⁶Department of Rheumatology, Chubu Rosai Hospital, Nagoya city, Aichi, Japan, ⁷Immuno-Rheumatology Center, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan, ⁸Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kamigyou, Kyoto, Japan, ⁹Department of Nephrology, Kyoto Katsura Hospital, Nishikyo-ku, Kyoto, Japan, ¹⁰Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan, ¹¹Department of General internal medicine, Tottori Red Cross Hospital, Tottori-city, Tottori, Japan, ¹²Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan, ¹³Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University School of Medicine, ¹-¹ Mukogawa-cho, Nishinomiya-shi, Hyogo, Japan, ¹⁴Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Takatsuki, Japan, ¹⁵Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan, ¹⁶Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan, ¹⁷Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan, ¹⁸Department of Rheumatology, Tokyo Kyosai Hospital, Meguro-ku, Tokyo, Japan, ¹⁹Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Nagano, Japan, ²⁰Department of Nephrology and Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan, ²¹Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan, ²²Division of Gastroenterology and Nephrology, Tottori University, Yonago, Tottori, Japan, ²³Department of Rheumatology, Shimane University Faculty of Medicine, Izumo-shi, Shimane, Japan, ²⁴Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo-shi, Nagasaki, Japan, ²⁵Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan, ²⁶Department of Rheumatology, Tohoku University Hospital, Sendai, Miyagi, Japan, ²⁷Division of Nephrology, Department of Internal Medicine, Teikyo University Chiba Medical Center, Ichiharashi, Chiba, Japan, ²⁸Department of Rheumatology, Institute of Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan, ²⁹Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR) Fukushima Medical University, Shirakawa, Fukushima, Japan, ³⁰The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto-city, Kyoto, Japan, ³¹Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-city, Kyoto, Japan, ³²Department of Clinical Assessment, Tokyo University of Pharmacy and Life Sciences, Hachioji-city, Tokyo, Japan, ³³Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan

Meeting: ACR Convergence 2025

Keywords: ANCA associated vasculitis, glucocorticoids

Session Information

Date: Tuesday, October 28, 2025

Title: (2504–2523) Vasculitis – ANCA-Associated Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Glucocorticoids (GCs) are a cornerstone of remission induction therapy in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA), but long-term GC use is associated with serious adverse effects. Therefore, minimizing GC exposure while maintaining disease control is a major therapeutic goal. However, the frequency and predictors of glucocorticoid-free clinical remission (GFCR) within the first year after treatment initiation remains unclear in patients with newly diagnosed MPA/GPA. This study aimed to investigate the rate and predictors of GFCR at week 48 in patients with newly diagnosed MPA or GPA, and to examine long-term outcomes up to week 96.

Methods: We conducted a retrospective cohort study using a multicenter, nationwide registry in Japan (J-CANVAS). Patients with newly diagnosed MPA or GPA and at least 48 weeks of follow-up were included. GFCR was defined as Birmingham Vasculitis Activity Score (BVAS) of 0 with complete GC withdrawal at week 48. Univariable and multivariable logistic regression analyses were used to identify factors associated with GFCR. Given the limited prior evidence regarding predictors of GFCR, variables for multivariable models were selected based on clinical relevance and statistical trends in univariable analysis (Model 1: p < 0.05, Model 2: p < 0.20).

Results: Among 728 patients with newly diagnosed MPA/GPA enrolled in the registry, 544 were included in the analysis. At week 48, 29 patients (5.3%) achieved GFCR. Baseline characteristics are shown in Figure 1, and treatment details and outcomes up to week 48 are summarized in Figure 2. In multivariable analysis, the use of rituximab (RTX) and avacopan within the first 24 weeks was independently associated with achieving GFCR, whereas methylprednisolone pulse therapy was negatively associated (RTX: odds ratio [OR] 5.16, 95% confidence interval [CI] 2.37–11.22; avacopan: OR 14.67, 95% CI 4.81–44.70; methylprednisolone pulse: OR 0.14, 95% CI 0.03–0.61). Baseline characteristics including age, sex, ANCA serotype, disease activity (BVAS), and organ involvement were not significantly associated (Figure 3). Patients who achieved GFCR at week 48 were more likely to maintain GFCR at week 96 (58.6% vs. 4.5%, p < 0.001). Between weeks 48 and 96, the rates of death, relapse, and serious infection were similar regardless of GFCR status at week 48.

Conclusion: In this real-world cohort, the use of RTX and avacopan was independently associated with achieving GFCR at week 48, supporting their role in GC-sparing therapeutic strategies for AAV. Prospective studies are needed to validate these findings and guide individualized treatment approaches.

Figure 1. Comparison of baseline characteristics between patients with and without GFCR at week 48

Figure 2. Comparison of treatment details and outcomes up to week 48 between patients with and without GFCR at week 48

Figure 3. Univariable and multivariable logistic regression analyses for predictors of GFCR at week 48

Disclosures: Y. Ushio: None; S. Omura: Janssen, 6, UCB, 6; D. Nakagomi: None; Y. Abe: None; M. Wada: None; N. Takizawa: None; A. Nomura: None; Y. Kukida: None; N. Kondo: None; H. Takagi: None; K. Endo: None; S. Hirata: AbbVie/Abbott, 6, Asahi-Kasei Pharma, 5, 6, Astellas, 6, AstraZeneca, 6, Ayumi, 6, Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 6, Chugai, 5, 6, Daiichi-Sankyo, 6, Eisai, 1, 6, Eli Lilly, 6, Gilead, 6, GlaxoSmithKlein(GSK), 6, Janssen, 6, Nihon-Shinyaku, 6, Novartis, 6, Otsuka Pharmaceutical, 5, 6, Pfizer, 6, Sandoz, 6, Taisho, 5, 6, Tanabe-Mitsubishi, 6, UCB, 6; N. Azuma: Asahi-Kasei Pharma, 5, 6, Eli Lilly, 5, 6; T. Takeuchi: None; S. Fukui: None; K. Kamada: None; R. Yanai: None; Y. Matsuo: None; Y. Shimojima: None; R. Nishioka: None; R. Okazaki: None; T. Takata: None; M. Moriyama: None; A. Takatani: None; Y. Miyawaki: None; T. Shirai: AbbVie/Abbott, 6, Asahi Kasei, 6, Astellas, 6, AstraZeneca, 6, Chugai, 6, Eli Lilly, 6, GlaxoSmithKlein(GSK), 6, Novartis, 6, Pfizer, 6, Sanofi, 6; T. Ito: None; I. Matsumoto: None; T. Takada: None; T. Ito-Ihara: None; T. Kida: None; N. Yajima: None; T. Kawaguchi: None; Y. Kawahito: None; H. Dobashi: None.

To cite this abstract in AMA style:

Ushio Y, Omura S, Nakagomi D, Abe Y, Wada M, Takizawa N, Nomura A, Kukida Y, Kondo N, Takagi H, Endo K, Hirata S, Azuma N, Takeuchi T, Fukui S, Kamada K, Yanai R, Matsuo Y, Shimojima Y, Nishioka R, Okazaki R, Takata T, Moriyama M, Takatani A, Miyawaki Y, Shirai T, Ito T, Matsumoto I, Takada T, Ito-Ihara T, Kida T, Yajima N, Kawaguchi T, Kawahito Y, Dobashi H. Predictors of Glucocorticoid-Free Clinical Remission at Week 48 in Newly Diagnosed Microscopic Polyangiitis and Granulomatosis with Polyangiitis: from nation-wide registry in Japan (J-CANVAS) [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/predictors-of-glucocorticoid-free-clinical-remission-at-week-48-in-newly-diagnosed-microscopic-polyangiitis-and-granulomatosis-with-polyangiitis-from-nation-wide-registry-in-japan-j-canvas/. Accessed .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-glucocorticoid-free-clinical-remission-at-week-48-in-newly-diagnosed-microscopic-polyangiitis-and-granulomatosis-with-polyangiitis-from-nation-wide-registry-in-japan-j-canvas/