OBJECTIVE: ANCA-associated vasculitis (AAV) is characterized by a chronic relapsing course. Rituximab (RTX) is an effective maintenance treatment; however, the long-term outcomes after its discontinuation are unclear. The aim of this study was to explore the long-term outcomes of AAV patients treated with repeat-dose RTX maintenance therapy. METHODS: AAV patients receiving a RTX treatment protocol consisting of an induction and maintenance phase were included. For initial remission induction, RTX was dosed at 1 g every 2 weeks or 375 mg/m(2) weekly for 4 consecutive weeks and for remission maintenance at 1 g every 6 months for 24 months. At the first RTX administration, ongoing immunosuppressives were withdrawn. RESULTS: Sixty-nine patients were identified, 67 of whom were failing other therapies. Nine relapsed during the RTX treatment protocol; however, all 69 were in remission at the end of the maintenance phase on a median prednisolone dose of 2.5 mg/day and 9% were receiving additional immunosuppression. During subsequent observation, 28 patients relapsed a median of 34.4 months after the last RTX infusion. Risk factors for relapse were PR3-associated disease (P = 0.039), B cell return within 12 months of the last RTX infusion (P = 0.0038) and switch from ANCA negativity to positivity (P = 0.0046). Two patients died and two developed severe hypogammaglobulinaemia. CONCLUSION: This study supports the efficacy and safety of a fixed-interval RTX maintenance regimen in relapsing/refractory AAV. Relapses after discontinuation of maintenance therapy did occur, but at a lower rate than after a single RTX induction course. PR3-associated disease, the switch from ANCA negative to positive and the return of B cells within 12 months of the last RTX administration were risk factors for further relapse.
Long-term follow-up of patients who received repeat-dose rituximab as maintenance therapy for ANCA-associated vasculitis / F. Alberici, R.M. Smith, R.B. Jones, D.M. Roberts, L.C. Willcocks, A. Chaudhry, K.G.C. Smith, D.R.W. Jayne. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 54:7(2015 Jul), pp. 1153-1160.
|Titolo:||Long-term follow-up of patients who received repeat-dose rituximab as maintenance therapy for ANCA-associated vasculitis|
ALBERICI, FEDERICO (Primo) (Corresponding)
|Parole Chiave:||B cells; anti-neutrophil cytoplasm antibody; biologic therapies; granulomatosis with polyangiitis; maintenance treatment; microscopic polyangiitis; vasculitis; Adult; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Incidence; Longitudinal Studies; Male; Middle Aged; Prednisolone; Recurrence; Retrospective Studies; Rituximab; Time Factors; Treatment Outcome|
|Settore Scientifico Disciplinare:||Settore MED/14 - Nefrologia|
|Data di pubblicazione:||lug-2015|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/rheumatology/keu452|
|Appare nelle tipologie:||01 - Articolo su periodico|