ANCA 管炎 - minds4.jcqhc.or.jp

1 ANC A .. Part 1.. Part1 .. 1 AAV . CPG . ANCA AAV CPG .. ANCA AAV . SR CPG . MPA GPA .. Wegener WG CPG . EGPA . Churg Strauss CSS GRADE CPG . MPA .. RLV CQ SR. AAV unclassifiable .. AAV . GC .. CPG CPG GRADE . AAV CPG Part 1 .. CPG . AAV . CPG CQ. AAV CPG 2011 Minds 2014 . 2014 CPG ANCA CQ .. 3 CPG .. GRADE . CPG . AAV .. 5 3 Part 2 ANCA . RTX .. CPG .. RPGN 2014 . CPG RPGN AAV . CPG . AAV . CPG GRADE CPG . 2.. CPG .. Part 1 CPG MPA GPA.. MPA GPA . AAV . Part 2 . 2 CPG .. CPG AAV CPG . AAV Part 1 AAV . SR . MPA. AAV . GPA EGPA . CPG . MPA GPA AAV . Part 2 MPA GPA EGPA AAV RPGN .. CPG .. 3 .. CPG AAV . AAV CPG 2015 1 .. 1 3 CQ1 1 1 16. CPG AAV CQ1 2 1 22 CQ1 3 . AAV CQ1 4 1 39 CQ1 5 . CPG 1 46 CQ1 6 . 2 1 CQ2 3 3 CQ3 1. CPG 3 14 CQ3 2 . AAV 3 21 CQ3 3 3 . AAV CPG 28 CQ3 4 3 35 CQ3 5 . AAV .. AAV CPG .. CPG . 4 . CQ CPG . Part 1 . Part 2 ANCA . 3. Part1 .. 1 3 . CPG Part 1 CPG . Part 2 ANCA CPG . Part 1.

2 COI 1 . Part 2 . COI CPG .. Part 1 CPG CPG SR .. SR . CPG . CPG . 1 .. COI CPG . 2 CPG SR .. CPG . CPG . 26 28 CPG . COI .. CPG .. 1 GRADE . 2 2015 250 251 . 4.. 1 50 .. 2 .. II.. GRADE working group member .. 5. Part1 .. 9 . 10. 1 GC 9 .. CPG . SR .. 1 . 1 1 . 2 1 . GC .. Walsh Hoboken 2010 62 1166 . M, et al. Arthritis Care Res 1173 . GC . CPG . GC SR . EUVAS .. 3 .. 2 . CPG .. SR .. ANCA RCT . AAV .. 3 . 1 Part 2 VIII 1 . p x .. p112 . QOL SF 36 . VDI . CPG .. QOL SF 36 VDI . GRADE . RCT . QOL SF 36 . VDI .. GC . 6 12 18 . 70% 18 42 . 10 .. 10 . 6.. 1 .. SF 36 . QOL VDI . 7 .. SF 36 . QOL. VDI .. VDI .. SF 36 . QOL. VDI SR . CQ2 . 2 .. QOL . 3 .. SF 36 CPG . SF 36 . CQ . CQ1 ANCA .. SR CQ2 ANCA .. CQ3 ANCA . 1 9 7 . 9 4 6 CQ . 1 3 CQ . 7 9 4 6 . 7 CQ .. 3 70% CPG CQ. 1 . 3 . 70% .. SR . SR CQ1 . GC GC .. POCY .. IVCY . GC POCY GC IVCY. 7. Part1 . 2 .. SF 36 . QOL.. SF 36 . QOL. VDI .. VDI .. SF 36.

3 QOL. GC IVCY GC . RTX GC AZA GC MTX. GC POCY GC RTX GC AZA GC MMF. GC POCY GC MTX GC AZA GC LEF . GC IVCY GC GC AZA GC A. CsA . MMF GC POCY GC MTX. GC POCY GC . AZA GC POCY GC AZA . GC IVCY6 GC IVCY12 . EGPA .. AAV GC POCY LEF . GC IVCY .. CQ CQ .. CQ2 CQ . CQ CQ1 ANCA . GC POCY GC . GC POCY CQ1 1 AAV GC GC POCY. GC POCY GC POCY IVCY . GC IVCY GC IVCY CQ1 2 AAV GC POCY . GC POCY GC IVCY . GC IVCY CQ1 3 AAV GC IVCY . PAN GC RTX . EGPA CQ1 4 AAV GC POCY . CQ GC RTX . EGPA . CQ1 5 AAV GC POCY . EGPA GC MTX . CQ1 6 AAV GC IVCY . CQ3 GC MMF . GC POCY GC AZA. GC AZA GC RTX. 8.. CQ2 ANCA CQ . CQ1 . CQ2 1 AAV AAV GC POCY GC AZA . GC POCY . E GPA GC IVCY6 GC . CQ2 2 AAV IVCY12 . GC POCY GC POCY AAV GC POCY . CQ3 ANCA GC IVCY . CQ2 . CQ3 1 AAV GC POCY AAV IVCY GC. GC AZA . CQ3 2 AAV GC AZA GC . RTX . CQ3 3 AAV GC AZA GC EGPA . MTX CQ3 . CQ3 4 AAV GC AZA GC AAV GC AZA GC LEF . MMF . CQ3 5 AAV GC POCY AAV GC POCY GC MTX.

4 GC CsA . AAV GC POCY . GC AZA . 9. Part1 .. 1 MPA GPA . EGPA PAN PAN EGPA .. SR . EGPA .. ANCA . AAV . RCT . 20 . 1994 PAN EGPA . SR .. 2 GRADE . Part 1 SR . CPG GRADE . 1,2 . GRADE CQ .. SR .. 2 .. 1 GRADE .. 2. 1 . peer review . SR CPG CPG . CQ patient . intervention . com 70% parison outcome PICO . CQ .. CPG 9 .. 1 . 9 7 .. 6 4 3 1 .. AAV SR . CQ PICO PubMed . PAN CENTRAL . AAV PAN . EGPA .. EGPA RCT . 1994 20 . 2015 1 . 10.. body of evidence .. RCT .. risk of bias .. 1. 1. risk of bias 1. large magnitude .. 2. 2. inconsistency SR 2.. 3. 3. indirectness dose response gradient . 4. 4. imprecision 3. confounders . 5.. PIC O. 5. publication bias . 6.. 7.. High / Moderate / Low / Very low .. Risk of bias summary Summary of Findings SoF Evidence Profile Risk of bias graph .. Evidence to Decision . Clinical Question CQ . Analytic Frameworks .. Forest plot . COI .. overall quality of evidence across outcomes.

5 Critical .. A / B / C / D .. / .. / .. / .. 1 . CQ Cochrane . fixed-effect model . Review SR random effects model inverse variance mean difference .. SR SD .. 2. 2 .. SR CQ . 2 2 2 SR . 2 .. GRADE working group . V high . moderate low very low 4 . RCT . CQ high 5. Cochrane Review Manager Rev RCT . http: revman . Man5 software ver. 3 . 5 . risk . random effects model of bias . inconsistency . indirect 95%CI ness . imprecision . publica tion bias 1 . 11. Part1 . 1 5 .. risk of bias .. inconsistency . indirectness PICO CQ PICO .. imprecision .. publication bias .. 2 risk of bias .. outcome . random sequence generation . selection bias .. allocation concealment selection . bias .. blinding of participants and personnel . performance bias .. blinding of outcome assessment . detection bias .. incomplete outcome data . attrition bias .. selective outcome reporting . reporting bias . other sources of bias.

6 2 RCT . RoBANS . 4 .. low high . unclear . 3 . RCT . Cochrane handbook for systematic heterogeneity . reviews of interventions version 2 RevMan5 I2 GRADE. low risk of Handbook 40% . bias 30 60% 50 90% 75 100%.. risk of bias . 1 2 .. indirectness . PICO CQ . 1 PICO . 12.. 3 4 4 .. high ++++ .. moderate +++ .. low ++ .. very low + .. SoF SoF . 1 2 . imprecision .. 2. 3 . optimal information size OIS .. 95%CI Rev- CQ . Man5 . SoF .. CQ . 95%CI . OIS .. 1 2 . publication bias .. qual- 10 ity con- funnel plot fidence certainty . 10 4 .. RCT 3 . large magnitude dose response gradient SoF. confounders Evidence high moderate . low . to Decision Framework Evidence to Decision .. very low 1,2 . 3 . Evidence to Decision .. SR . SoF .. http: . GRADE pro GDT SR .. 13. Part1 .. 2 . 5 .. high . moderate . low . very low .. 4 . CPG . 2 . 5 . 2. 4 .. 1 GRADE working group. http: . 2 GRADE . 2 2015 250 251 . 3 Higgins JPT, et al.

7 Cochrane handbook for systematic reviews of interventions version .. http: 4 Kim SY, P et al. J Clin Epidemiol 2013 66 408 414.. 14.. 1 CQ1 . CQ 1 ANCA .. ANCA .. ANCA .. ANCA . #1.. #2.. ANCA .. ANCA.. 1 . 2 . 2 Part 1 I 4 . p viii . p3 . 1 ANCA . 2 RPGN . 3 Part 2 VIII . p112 . 15. Part1 . 2 CQ1 . CQ 1 ANCA . ANCA . CQ 1 1 .. ANCA . CQ 1 2 .. ANCA .. ANCA .. 1 ANCA . 2 RPGN . 3 Part 2 VIII . p112 . 2. 1 2. 2 . ANCA AAV GC GC CY . CPG SR . GC MPO ANCA . CY CPG GC 1 . 20 RCT . CY ANCA MPA . GC CY RLV 1 . 64 . GC .. 2011 CPG 2 . AAV GC GC POCY GC IVCY SR 3. 1 RCT 199 1 . GC CY GC IVCY GC POCY .. 1 2 . GC GC CY GC CY .. CY GC POCY . GC POCY GC IVCY. I V C Y 50. POCY 18 80 . mg . 2 3 mg dL. 1 17 CQ1 2. dL . 16.. RCT . GC CY . GC CY . GC CY. 2. 3 . GC . GC GC CY .. GC GC CY RemIT JAV . 1 RCT 1 RCT . GC. RCT g kg GC .. SR . very low 3 . GC POCY GC IVCY 3 GC CY GC . RCT 1 . GC POCY GC IVCY . GC IVCY GC POCY.

8 Mod- . 1 2 .. erate very low .. GC IVCY . 1 GC IVCY .. very low . GC IVCY . 1 GC POCY .. Monach 5 .. POCY . SR OR 100 100 g GC GC CY 30 g . 2 GC IVCY . GC . 3 IVCY GC POCY . CY . EULAR KDIGO . 4 .. http: home glomerulonephritis gn . GC CY . GC CY GC . GC CY . 3 . RCT .. very low .. GC GC CY . 3 1 1 CQ1 . 1 , 1 9 CQ1 1 . RCT 1 10 CQ1 1 . RCT AAV GC GC CY. 17. Part1 . GC GC CY CY . IVCY . GC POCY GC IVCY .. CY . GRADE.. 6,7 .. GC GC CY AAV Part 2 3 EULAR . GC CY GC Part 2 VIII . p161 . CY p138 GC .. GC POCY GC IVCY GC IVCY . 2. 4 . 114,820 . AAV MPA RPGN . ANCA RPGN . 0 23,100 . 0 11,550 . RPGN 2014 8 . 3 20% 6 CPG . 60% GC IVCY CPG Nachman 3 KDIGO . GC POCY GC B S R B H P R . IVCY EULAR CPG . GC IVCY GC. IVCY POCY .. CPG .. GC SR . GC CY . 2. 5 .. CY Part 2 VI . p93 . VIII . 3 GC CY . p114 . RCT p119 .. GC . 2. 6 . CY . GC CY AAV GC CY . GC . GC CY GC CY CPG . GC GC . GC CY AAV . CPG . GC CY . 18.

9 AAV 4 Mukhtyar C, et al European Vasculitis Study Group. Ann Rheum Dis 2009 68 310 317. RTX . 5 Monach PA, et al. Arthritis Rheum 2010 62 9 21. 6 2011 53 . RTX 509 555 . 7 ANCA . IL 6 2011 . AAV http: minds ANCA 8 . RPGN 2014 2014.. 2. 7 1 1 CQ1 1 . 1 2 CQ1 1 Evidence to Decision . CQ1 1 RCT . 1 3 CQ1 1 . 2002 29 221 228 . 1 4 CQ1 1 RCT . CQ1 1 RCT . 1 5 CQ1 1 RCT . Nakaya I, et al. Intern Med 2013 52 2503 2509. 1 6 CQ1 1 RCT . CQ1 2 RCT . 1 7 CQ1 1 RCT . de Groot K, et al. Ann Intern Med 2009 150 670 680. 1 8 CQ1 1 SoF RCT . Harper L, et al. Ann Rheum Dis 2012 71 955 960. 1 9 CQ1 1 RCT . Haubitz M, et al. Arthritis Rheum 1998 41 1835 1844. 1 10 CQ1 1 RCT . Guillevin L, et al. Arthritis Rheum 1997 40 2187 2198. 1 11 CQ1 1 RCT . 1 12 CQ1 1 RCT . 1 13 CQ1 1 SoF RCT . 1 14 CQ1 2 . 2. 8 Evidence to Decision 1 15 CQ1 2 Evidence to Decision . 1 16 CQ1 2 . CQ1 1 CQ1 2 1 17 CQ1 2 RCT . 1 18 CQ1 2 RCT . 1 19 CQ1 2 RCT.

10 1 20 CQ1 2 RCT . 1 1 21 CQ1 2 SoF RCT . 22 2011 127 130 RCT CQ 9. 2 Hoffman GS, et al. Ann Intern Med 1992 116 488 498.. 3 Nachman PH, et al. J Am Soc Nephrol 1996 7 33 39.. 19. Part1 . 3 CQ1 . CQ 1 ANCA . ANCA . CQ 1 3.. ANCA . CQ 1 4.. ANCA . #1.. #2.. ANCA .. 1 . 2 . 1 ANCA . 2 RPGN . p112 . 3 Part 2 VIII . ANCA . 3. 1 .. RiCRAV . 5 .. AAV GC CY AAV GC RTX . GPA . RTX 2001 GC CY . AAV RTX RTX . B GPA MPA CQ . RTX GC CY IVCY POCY . GC RTX .. RAVE RITUXVAS . 1,2 . GC RTX . RTX . 2011 4 2012 1. GPA MPA RTX . 3. 2 . 2008 EULAR . 3 GC CY GC RTX GC CY GC IVCY .. CQ1 3 GC POCY . CQ1 4 . RTX . 2014 BSR BHPR 4 GC IVCY GC RTX . CQ1 3 . GC RTX 2016 SR . EULAR recommendation GPA MPA RLV 1 RCT 44 .. 2013 6 14 RTX . 10 mg mL GPA MPA .. AAV . RTX . GC POCY GC RTX CQ1 4 . 20.. BVAS 3 ANCA GPA MPA GC CY . 1 RCT 197 GC RTX . QOL .. QOL .. GC IVCY GC RTX GC RTX GC IVCY .. GFR 1 3 GC IVCY 12 45% GC IVCY. 9 33 mL m2 GC RTX 20 5 44 mL.