Rituximab in relapsed/refractory antineutrophil cytoplasmic antibody associated vasculitis: A single-center prospective observational study
Autor: | Raval Dhiren, Bindroo Muzaffar, Rajiva Gupta, Tanna Dhaval, Sharma Lucky, Ekbote Gayatri, Negalur Natasha |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system Cyclophosphamide Antineutrophil cytoplasmic antibody-associated vasculitis Birmingham Vasculitis Activity Score Single Center Gastroenterology 03 medical and health sciences 0302 clinical medicine rituximab Rheumatology Refractory Internal medicine medicine 030212 general & internal medicine Anti-neutrophil cytoplasmic antibody 030203 arthritis & rheumatology granulomatosis with polyangiitis business.industry medicine.disease Rituximab lcsh:RC925-935 Granulomatosis with polyangiitis business Vasculitis medicine.drug |
Zdroj: | Indian Journal of Rheumatology, Vol 14, Iss 1, Pp 12-16 (2019) |
ISSN: | 0973-3701 0973-3698 |
Popis: | Background: Induction with cyclophosphamide (CYC) and glucocorticoids in antineutrophil cytoplasmic antibody-associated vasculitis (AAV) has a relapse of 30%–50%. Studies show that rituximab (RTX) is superior to CYC in refractory/relapsed AAV. We prospectively analyzed efficacy and safety of RTX in CYC-failed cases of AAV. Methods: Patients with AAV who relapsed or were refractory to CYC therapy were given RTX 1 gm at 0 and 15 days, followed by maintenance with 500 mg every 4–6 months. All patients received oral prednisolone. Disease activity was defined by Birmingham Vasculitis Activity Score/Wegener's granulomatosis (BVAS/WG). Remission was defined by the European League Against Rheumatism criteria. Results: From August 2012 to July 2018, 67 patients with AAV were seen at our center; 21 patients who relapsed after inductions with CYC or were refractory to CYC received RTX; 8 (38%) were refractory and 13 (62%) were relapsed AAV; 20 were anti-proteinase 3 positive and 1 was anti-myeloperoxidase positive. All were granulomatosis with polyangiitis (GPA). Mean time to relapse was 12.04 ± 7.8 months. Most common indication for RTX was lung followed by ophthalmic, renal, ear nose throat, and nervous system involvement. Median follow-up after induction with RTX was 24 months. Mean BVAS/WG was 11.2 at baseline, 0.66 at the end of 3 months, 0.16 at the end of 6 months, and remained stable at that value at 18 months. At 24 months, 16 patients (76.19%) remained in remission. One was refractory to RTX treatment even after 2 years. Two patients died and two were still under follow-up. Conclusion: In our experience, RTX is a good induction and maintenance strategy for relapsed/refractory AAV. |
Databáze: | OpenAIRE |
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