OBJECTIVE: To conduct a long-term, prospective, randomized controlled trial evaluating rituximab (RTX) therapy for severe mixed cryoglobulinemia or cryoglobulinemic vasculitis (CV). METHODS: Fifty-nine patients with CV and related skin ulcers, active glomerulonephritis, or refractory peripheral neuropathy were enrolled. In CV patients who also had hepatitis C virus (HCV) infection, treatment of the HCV infection with antiviral agents had previously failed or was not indicated. Patients were randomized to the non-RTX group (to receive conventional treatment, consisting of 1 of the following 3: glucocorticoids; azathioprine or cyclophosphamide; or plasmapheresis) or the RTX group (to receive 2 infusions of 1 gm each, with a lowering of the glucocorticoid dosage when possible, and with a second course of RTX at relapse). Patients in the non-RTX group who did not respond to treatment could be switched to the RTX group. Study duration was 24 months. RESULTS: Survival of treatment at 12 months (i.e., the proportion of patients who continued taking their initial therapy), the primary end point, was statistically higher in the RTX group (64.3% versus 3.5% [P < 0.0001]), as well as at 3 months (92.9% versus 13.8% [P < 0.0001]), 6 months (71.4% versus 3.5% [P < 0.0001]), and 24 months (60.7% versus 3.5% [P < 0.0001]). The Birmingham Vasculitis Activity Score decreased only after treatment with RTX (from a mean ± SD of 11.9 ± 5.4 at baseline to 7.1 ± 5.7 at month 2; P < 0.001) up to month 24 (4.4 ± 4.6; P < 0.0001). RTX appeared to be superior therapy for all 3 target organ manifestations, and it was as effective as conventional therapy. The median duration of response to RTX was 18 months. Overall, RTX treatment was well tolerated. CONCLUSION: RTX monotherapy represents a very good option for severe CV and can be maintained over the long term in most patients
A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis / S. De Vita, L. Quartuccio, M. Isola, C. Mazzaro, P. Scaini, M. Lenzi, M. Campanini, C. Naclerio, A. Tavoni, M. Pietrogrande, C. Ferri, M. T. Mascia, P. Masolini, A. Zabotti, M. Maset, D. Roccatello, A. L. Zignego, P. Pioltelli, A. Gabrielli, D. Filippini, O. Perrella, S. Migliaresi, M. Galli, S. Bombardieri, G. Monti. - In: ARTHRITIS AND RHEUMATISM. - ISSN 0004-3591. - 64:3(2012 Mar), pp. 843-853.
|Titolo:||A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis|
|Settore Scientifico Disciplinare:||Settore MED/16 - Reumatologia|
|Data di pubblicazione:||mar-2012|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1002/art.34331|
|Appare nelle tipologie:||01 - Articolo su periodico|