Evaluation of PR3-ANCA Status After Rituximab for ANCA-Associated Vasculitis
| Autor: | Joanna Tieu, David Jayne, Seerapani Gopaluni, Rachel B Jones, Rona M Smith, Mark McClure, James Wason |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Myeloblastin Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis Enzyme-Linked Immunosorbent Assay ANCA-Associated Vasculitis urologic and male genital diseases Gastroenterology Article Antibodies Antineutrophil Cytoplasmic Disease activity 03 medical and health sciences Remission induction 0302 clinical medicine Rheumatology immune system diseases Internal medicine medicine Humans Immunologic Factors cardiovascular diseases 030212 general & internal medicine Established diagnosis skin and connective tissue diseases Glucocorticoids Anti-neutrophil cytoplasmic antibody 030203 arthritis & rheumatology biology business.industry Remission Induction Middle Aged medicine.disease respiratory tract diseases biology.protein Female Rituximab Antibody Vasculitis business Biomarkers medicine.drug |
| Zdroj: | J Clin Rheumatol |
| ISSN: | 1536-7355 1076-1608 |
| Popis: | INTRODUCTION: The value of antineutrophil cytoplasmic antibody (ANCA) measurements among patients with an established diagnosis of ANCA-associated vasculitis (AAV) to assess disease activity or predict relapse remains controversial, but recent evidence suggests a possible role for rituximab-treated patients. PATIENTS AND METHODS: All patients with active vasculitis and positive proteinase 3 (PR3)–ANCA who were starting a 2-year treatment course of rituximab for induction of remission at Addenbrooke’s Hospital between January 2011 and January 2016 were included in this study. Common department practice consists of 6 g of rituximab given over 2 years, concomitant corticosteroids (0.5–1.0 mg/kg) with rapid taper over 3 months, and cessation of oral maintenance immunosuppressive agents at time of first rituximab dose. Clinical and laboratory data were collected retrospectively using electronic patient records. RESULTS: Fifty-seven patients with current PR3-ANCA positivity were included in the analysis. Median follow-up was 59 months. PR3-ANCA negativity was achieved in 25 patients (44%) with a median time of 14 months. Clinical remission was achieved in 53 patients (93%) with a median time of 3 months. Among the 53 patients who achieved remission during follow-up, 24 (45%) relapsed with a median time to relapse of 36 months from remission. Both PR3-ANCA–negative status and 50% reduction in PR3-ANCA from baseline (as time-varying covariates) were significantly associated with a longer time to relapse (PR3-ANCA–negative status: hazards ratio, 0.08 [95% confidence interval, 0.01–0.63, p = 0.016]; 50% reduction in PR3-ANCA: hazards ratio, 0.25 [95% confidence interval, 0.18–0.99, p = 0.046]). CONCLUSIONS: Achieving and maintaining PR3-ANCA negativity after rituximab was associated with longer-lasting remission. |
| Databáze: | OpenAIRE |
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