Combination Therapy With Rituximab and Cyclophosphamide for Remission Induction in ANCA Vasculitis.
| Autor: | Cortazar FB; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Boston, Massachusetts, USA., Muhsin SA; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Center for Systems Biology, Program in Membrane Biology, Massachusetts General Hospital, Boston, Massachusetts, USA., Pendergraft WF 3rd; University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, Chapel Hill, North Carolina, USA., Wallace ZS; Division of Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA., Dunbar C; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Boston, Massachusetts, USA., Laliberte K; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Boston, Massachusetts, USA., Niles JL; Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Vasculitis and Glomerulonephritis Center, Massachusetts General Hospital, Boston, Massachusetts, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Kidney international reports [Kidney Int Rep] 2017 Nov 14; Vol. 3 (2), pp. 394-402. Date of Electronic Publication: 2017 Nov 14 (Print Publication: 2018). |
| DOI: | 10.1016/j.ekir.2017.11.004 |
| Abstrakt: | Introduction: Remission induction in antineutrophil cytoplasmic autoantibody (ANCA) vasculitis may be complicated by slow response to treatment and toxicity from glucocorticoids. We describe outcomes with a novel remission induction regimen combining rituximab with a short course of low-dose, oral cyclophosphamide and an accelerated prednisone taper. Methods: Patients were included in this retrospective study if they had newly diagnosed or relapsing ANCA vasculitis with a Birmingham Vasculitis Activity Score for Wegener Granulomatosis (BVAS-WG) ≥3 and received a standardized remission induction regimen. The primary outcome was complete remission, defined as a BVAS-WG of 0 and a prednisone dose of ≤7.5 mg/d. Results: We identified 129 patients who met the inclusion criteria, 31% of whom also received plasma exchange (PLEX) for rapidly progressive glomerulonephritis (RPGN) or diffuse alveolar hemorrhage. Seventy percent of patients had myeloperoxidase (MPO)-ANCA and 9% had relapsing disease. Median time to complete remission was 4 months (interquartile range [IQR] 3.9-4.4), and by 5 months 84% of patients were in complete remission. Prednisone was tapered to discontinuation as tolerated, such that the median prednisone dose at 8 months was 0 mg/d (IQR 0-2.5). In patients with RPGN, proteinase 3-ANCA was associated with a greater increase in eGFR at 6 months compared with MPO-ANCA (16 vs. 5.6 ml/min per 1.73m 2 ; P = 0.028). During the year following remission, 1 major relapse occurred over 122 patient-years. Serious infections occurred more frequently in patients receiving PLEX and were associated with increasing age and diffuse alveolar hemorrhage. Four deaths occurred, 3 of which were associated with serious infections. Conclusion: Combination therapy was efficacious, allowed for rapid tapering of high-dose glucocorticoids and was well tolerated. |
| Databáze: | MEDLINE |
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