Rheumatology Medical News about refractory antineutrophil cytoplasmic antibody-associated vasculitis;rituximab therapy

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A multicenter survey of rituximab therapy for refractory antineutrophil cytoplasmic antibody-associated vasculitis
Arthritis & Rheumatism, 07/08/09

Jones RB et al. – Data demonstrate that rituximab was effective remission induction therapy for refractory ANCA-associated vasculitis. Continuing immunosuppression did not reduce relapses. ANCA and B cell levels lacked sufficient sensitivity to guide the timing of re-treatment.

Methods

Aim was to determine the efficacy and safety of rituximab for ANCA-associated vasculitis
ANCA and B cell levels were investigated as re-treatment biomarkers.
Retrospective, data collection from 65 sequential pts at 4 centers in the UK

Results

All pts achieved B cell depletion; complete remission occurred in 75%, PR in 23%, and no response in 2%
Prednisolone dosage was reduced from 12.5 mg/d to 9.0 mg/d at 6 mo
Immunosuppressive therapy was withdrawn in 62% pts
57% pts who achieved full remission experienced relapse at 11.5 mo
B cell return preceded relapse in 52%
Although ANCA levels fell after rituximab therapy, relapse was not associated with ANCA positivity or a rise in ANCA levels
Neither the initial rituximab regimen nor withdrawal of immunosuppressive therapy influenced the timing of relapse
38 pts received 2 courses of rituximab, and complete remission was induced or maintained in 32 of them (84%)
IgM levels fell, although IgG levels remained stable
46 serious AEs occurred, including 2 episodes of late-onset neutropenia, which were attributed to rituximab

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