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

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Smith, RM
Jones, RB
Specks, U
Bond, S
Nodale, M
Aljayyousi, R
Andrews, J
Bruchfeld, A
Camilleri, B
Carette, S
Cheung, CK
Derebail, V
Doulton, T
Ranganathan, D
et al.
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2020
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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/m 2) 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.

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Annals of the Rheumatic Diseases

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79

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9

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Clinical sciences

Immunology

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Public health

B cells

granulomatosis with polyangiitis

systemic vasculitis

treatment

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Smith, RM; Jones, RB; Specks, U; Bond, S; Nodale, M; Aljayyousi, R; Andrews, J; Bruchfeld, A; Camilleri, B; Carette, S; Cheung, CK; Derebail, V; Doulton, T; Ranganathan, D; et al., Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis, Annals of the Rheumatic Diseases, 2020, 79 (9), pp. 1243-1249