Rituximab for remission maintenance in relapsing ANCA-associated vasculitis
Arthritis & Rheumatism, 06/26/2012
Smith RM et al. – Two year fixed interval routine rituximab re–treatment was associated with a reduction in relapse rates during the re–treatment period and a more prolonged period of remission during subsequent follow–up. In the absence of biomarkers that accurately predict relapse, routine rituximab re–treatment may be an effective strategy for remission maintenance in refractory and relapsing ANCA associated vasculitis (AAV).Methods
- Single centre retrospective, standardised data collection from sequential patients receiving rituximab for refractory or relapsing AAV.
- Group A (n=28) received rituximab induction (375mg/m2x4 or 2x1g), and further rituximab at the time of subsequent relapse.
- Group B (n=45) received routine rituximab re–treatment for two years; 2x1g induction, then 1g every 6 months (6g total).
- Group C (n=19) comprised Group A patients who subsequently relapsed and commenced routine re–treatment for two years.
- Response (complete/partial remission) occurred in 26/28 (93%) Group A, 43/45 (96%) Group B and 18/19 (95%) Group C.
- At two years, relapses had occurred in 19/26 (73%) Group A, 5/43 (12%) Group B (p<0.001) and 2/18 (11%) Group C (p<0.001).
- At last follow–up, median 44 months, relapses had occurred in 85% (22/26) Group A, 26% (11/43) Group B (p<0.001) and 56% (10/18) Group C (p=0.001).
- Glucocorticoid doses fell and immunosuppression was withdrawn in the majority.
- Routine rituximab re–treatment was well tolerated and no new safety issues were identified.