The Renaissance of Antineutrophil Cytoplasmic Antibodies as a Predictor of Relapse:<i>Ippon</i>for Japan
Bibliographic record
Abstract
In 1985, van der Woude, et al described antineutrophil cytoplasmic antibodies (ANCA) in granulomatosis and polyangiitis (GPA, formerly Wegener’s granulomatosis) and suggested that ANCA might be a useful tool for disease activity1. Subsequently, we started a prospective study in which ANCA was measured every month in patients with GPA with both physician and patient blinded to ANCA results. During a period of 16 months, 18 of 35 patients demonstrated a rise in ANCA levels; and in 17 of 18 patients, relapse followed2. Subsequently, we started a prospective trial, where patients were randomized after an ANCA rise to receive either preemptive therapy using a 9-month course of cyclophosphamide and 3 months of corticosteroids or no therapy until clinical relapse occurred. During a period of 24 months, 20 of 58 patients had ANCA rises. Nine patients were randomized for treatment and none relapsed, whereas 9 out of 11 patients were randomized for no therapy and developed a relapse. Importantly, patients receiving no treatment at the time of ANCA rise ultimately received more cyclophosphamide and prednisolone than patients on preemptive treatment3. Later, in an open-label study, the group of Niles, et al confirmed that preemptive increases in immunosuppression following ANCA rises reduced the risk of relapse4. During the next decades, several observational studies without intervention were performed. From these studies, it was concluded that the value of repeated ANCA measurements among patients with ANCA associated vasculitis (AAV) is limited and it became more or less unethical to treat AAV patients based on ANCA levels5. In the current issue of The Journal , Yamaguchi, et al report their findings on the occurrence of ANCA rises and preemptive increases in immunosuppression following ANCA rises in their Japanese cohort of patients with AAV. In this study, … Address correspondence to Prof. Cohen Tervaert, Clinical and Experimental Immunology, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, the Netherlands. E-mail: jw.cohentervaert{at}maastrichtuniversity.nl
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".