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Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis

Smith, Rona M.; Jones, Rachel Bronwen; Specks, Ulrich; Bond, Simon; Nodale, Marianna; Aljayyousi, Reem; Andrews, Jacqueline; Bruchfeld, Annette; Camilleri, Brian; Carette, Simon; Cheung, Chee Kay; Derebail, Vimal; Doulton, Tim; Forbess, Lindsy; Fujimoto, Shouichi; Furuta, Shunsuke; Gewurz-Singer, Ora; Harper, Lorraine; Ito-Ihara, Toshiko; Khalidi, Nader; Klocke, Rainer; Koening, Curry; Komagata, Yoshinori; Langford, Carol; Lanyon, Peter; Luqmani, Raashid Ahmed; Makino, Hirofumi; McAlear, Carole; Monach, Paul; Moreland, Larry W; Mynard, Kim; Nachman, Patrick; Pagnoux, Christian; Pearce, Fiona; Peh, Chen Au; Pusey, Charles; Ranganathan, Dwarakanathan; Rhee, Rennie L; Spiera, Robert; Sreih, Antoine G; Tesar, Vladimir; Walters, Giles; Weisman, Michael H.; Wroe, Caroline; Merkel, Peter; Jayne, David

Authors

Rona M. Smith ronasmith@doctors.net.uk

Rachel Bronwen Jones

Ulrich Specks

Simon Bond

Marianna Nodale

Reem Aljayyousi

Jacqueline Andrews

Annette Bruchfeld

Brian Camilleri

Simon Carette

Chee Kay Cheung

Vimal Derebail

Tim Doulton

Lindsy Forbess

Shouichi Fujimoto

Shunsuke Furuta

Ora Gewurz-Singer

Lorraine Harper

Toshiko Ito-Ihara

Nader Khalidi

Rainer Klocke

Curry Koening

Yoshinori Komagata

Carol Langford

Peter Lanyon

Raashid Ahmed Luqmani

Hirofumi Makino

Carole McAlear

Paul Monach

Larry W Moreland

Kim Mynard

Patrick Nachman

Christian Pagnoux

FIONA PEARCE Fiona.Pearce@nottingham.ac.uk
Clinical Associate Professor

Chen Au Peh

Charles Pusey

Dwarakanathan Ranganathan

Rennie L Rhee

Robert Spiera

Antoine G Sreih

Vladimir Tesar

Giles Walters

Michael H. Weisman

Caroline Wroe

Peter Merkel

David Jayne



Abstract

Objectives: Evaluation of rituximab and glucocorticoids as therapy to induce remission after relapse in ANCA-associated vasculitis (AAV) in a prospective observational cohort of patients enrolled into the induction phase of the RITAZAREM trial.

Methods: Patients relapsing with granulomatosis with polyangiitis or microscopic polyangiitis were prospectively enrolled and received remission-induction therapy with rituximab (4×375 mg/m2) and a higher or lower dose glucocorticoid regimen, depending on physician choice: reducing from either 1 mg/kg/day or 0.5 mg/kg/day to 10 mg/day by 4 months. Patients in this cohort achieving remission were subsequently randomised to receive one of two regimens to prevent relapse.

Results: 188 patients were studied: 95/188 (51%) men, median age 59 years (range 19–89), prior disease duration 5.0 years (range 0.4–34.5). 149/188 (79%) had previously received cyclophosphamide and 67/188 (36%) rituximab. 119/188 (63%) of relapses had at least one major disease activity item, and 54/188 (29%) received the higher dose glucocorticoid regimen. 171/188 (90%) patients achieved remission by 4 months. Only six patients (3.2% of the study population) did not achieve disease control at month 4. Four patients died in the induction phase due to pneumonia (2), cerebrovascular accident (1), and active vasculitis (1). 41 severe adverse events occurred in 27 patients, including 13 severe infections.

Conclusions: This large prospective cohort of patients with relapsing AAV treated with rituximab in conjunction with glucocorticoids demonstrated a high level of efficacy for the reinduction of remission in patients with AAV who have relapsed, with a similar safety profile to previous studies.

Journal Article Type Article
Publication Date 2020-09
Journal Annals of the Rheumatic Diseases
Print ISSN 0003-4967
Electronic ISSN 1468-2060
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 79
Issue 9
Pages 1243-1249
APA6 Citation Smith, R. M., Jones, R. B., Specks, U., Bond, S., Nodale, M., Aljayyousi, R., …Jayne, D. (2020). Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis. Annals of the Rheumatic Diseases, 79(9), 1243-1249. https://doi.org/10.1136/annrheumdis-2019-216863
DOI https://doi.org/10.1136/annrheumdis-2019-216863
Keywords Immunology; General Biochemistry, Genetics and Molecular Biology; Immunology and Allergy; Rheumatology
Publisher URL https://ard.bmj.com/content/early/2020/06/24/annrheumdis-2019-216863

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