Comparing Rituximab and Cyclophosphamide in Induction Therapy for Childhood-Onset Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: An ARChiVe Registry Cohort Study.

Autor: Gagne SJ; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Sivaraman V; Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio., Bosman ES; British Columbia Children's Hospital, Vancouver, British Columbia, Canada., Klamer B; The Ohio State University School of Biomedical Science, Columbus, Ohio., Morishita KA; British Columbia Children's Hospital, Vancouver, British Columbia, Canada., Huber A; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada., Orjuela A; Baylor College of Medicine and Texas Children's Hospital, Houston., Eberhard B; Cohen Children's Northwell Health, New Hyde Park, New York., Myrup C; Copenhagen University Hospital, Copenhagen, Denmark., Gerstbacher D; Stanford Children's Hospital, Palo Alto, California., Foell D; University of Muenster, Muenster, Germany., Al-Abadi E; Birmingham Children's Hospital, Birmingham, United Kingdom., McErlane F; Great North Children's Hospital and Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, United Kingdom., Cook K; Akron Children's Hospital, Akron, Ohio., Wagner-Weiner L; The University of Chicago Medical Center, Chicago, Illinois., Elder M; University of Florida, Gainesville, Florida., Moorthy LN; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Dancey P; Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada., Yeung R; The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada., Khubchandani R; SRCC Children's Hospital, Mumbai, Mumbai, India., Deepak S; Nottingham Children's Hospital, Nottingham, United Kingdom., Charuvanij S; Riley Hospital for Children at Indiana University Health, Indianapolis., Tarvin S; Seattle Children's Hospital, Seattle, Washington., Shenoi S; Montefiore Hospital and Medical Center, Bronx, New York., Tanner T; Siriraj Hospital, Mahidol University, Bangkok, Thailand., Brown K; British Columbia Children's Hospital, Vancouver, British Columbia, Canada., Cabral DA; British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Arthritis care & research [Arthritis Care Res (Hoboken)] 2024 Oct 28. Date of Electronic Publication: 2024 Oct 28.
DOI: 10.1002/acr.25455
Abstrakt: Objective: Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are chronic life-threatening vasculitides requiring substantial immunotherapy. Adult trials identified rituximab (RTX) as an alternative to cyclophosphamide (CYC) for remission induction of GPA and MPA. Disease rarity has limited feasibility of similar trials with pediatric patients. We aim to evaluate the relative efficacy and toxicity of CYC and RTX for patients with childhood GPA and MPA through registry-based comparative evaluation.
Methods: From A Registry of Childhood Vasculitis, we identified patients with GPA and MPA who received induction with RTX or CYC. Pediatric Vasculitis Activity Score (PVAS) and Pediatric Vasculitis Damage Index (pVDI) score evaluated disease activity and damage. Descriptive statistics summarized patient characteristics. RTX and CYC comparisons used logistic regression for primary outcomes of postinduction remission (PVAS = 0) or low disease activity (PVAS ≤ 2). Hospital admission for adverse events and pVDI scores were compared using logistic regression and ordinal regression, respectively.
Results: Among 104 patients, 43% received RTX, 46% CYC, 11% both. Treatment groups did not significantly differ for diagnosis PVAS and onset age. There was no difference in remission among the groups (63% overall; odds ratio [OR] 1.07, 95% confidence interval [CI] 0.45-2.52). Hospitalizations occurred in 22% of patients receiving RTX versus 10% patients receiving CYC (OR 2.27, 95% CI 0.73-7.05). The median 12-month pVDI score was 1 in both groups (OR 0.98, 95% CI 0.43-2.22).
Conclusion: This is the first study comparing CYC and RTX for induction in pediatric GPA and MPA. No significant differences were shown in rates of remission, severe adverse events, or organ damage. Limitations included lack of standardized treatment regimens, retrospectivity, and lack of longitudinal adverse drug-related event data.
(© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)
Databáze: MEDLINE
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