Rituximab for anti-neutrophil cytoplasmic antibodies-associated vasculitis: experience of a single center and systematic review of non-randomized studies

被引:16
作者
Ayan, Gizem [1 ]
Esatoglu, Sinem Nihal [2 ]
Hatemi, Gulen [2 ]
Ugurlu, Serdal [2 ]
Seyahi, Emire [2 ]
Melikoglu, Melike [2 ]
Fresko, Izzet [2 ]
Ozdogan, Huri [2 ]
Yurdakul, Sebahattin [2 ]
Hamuryudan, Vedat [2 ]
机构
[1] Istanbul Univ, Cerrahpasa Med Sch, Cerrahpasa Med Fac, Dept Internal Med, Istanbul, Turkey
[2] Istanbul Univ, Cerrahpasa Med Sch, Cerrahpasa Med Fac, Div Rheumatol,Dept Internal Med, Istanbul, Turkey
关键词
Systemic vasculitis; Rituximab; ANCA-vasculitis; Treatment; Granulomatosis with polyangiitis; ANCA-ASSOCIATED VASCULITIS; REFRACTORY GRANULOMATOUS MANIFESTATIONS; OPHTHALMIC WEGENERS-GRANULOMATOSIS; TERM-FOLLOW-UP; REMISSION INDUCTION; POLYANGIITIS WEGENERS; MAINTENANCE THERAPY; RELAPSING GRANULOMATOSIS; AUTOIMMUNE-DISEASES; CASE SERIES;
D O I
10.1007/s00296-018-3928-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Rituximab (RTX) is becoming a standard treatment for patients with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) but heterogeneity exists regarding its use. We present our uncontrolled experience with RTX in patients with refractory AAV and also the results of a systematic review of non-randomized studies on RTX in AAV patients. We retrospectively reviewed the records of AAV patients treated with RTX following an inadequate response to immunosuppressives between 2011 and 2015. The systematic review covered all English articles listed in PubMed until June 2017. There were 25 AAV patients (21 GPA, four unclassified) treated with RTX (median 2, IQR 1-3 courses; median follow-up 24, IQR 17-50 months). The kidney and the lung were the most commonly affected organs, observed in 14 and 16 patients, respectively. Complete remission rate was 72% at month 6 and 88% at month 12. Two patients had died and three serious adverse events occurred. The systematic review included 56 studies on 1422 patients with the majority being on refractory or relapsing disease. There was wide variability regarding disease characteristics, endpoints, concomitant immunosuppressives and RTX schedule. Most studies reported > 80% complete or partial remission rates with the lowest response (37.5%) for granulomatous lesions. The relapse rate was 30%. Infections and infusion reactions were the main adverse events. Our experience with RTX in refractory AAV is in line with the literature in terms of efficacy and safety. The systematic review underlines many uncertainties on its optimal use.
引用
收藏
页码:607 / 622
页数:16
相关论文
共 71 条
[1]   Lack of efficacy of rituximab in Wegener's granulomatosis with refractory granulomatous manifestations [J].
Aries, P. M. ;
Hellmich, B. ;
Voswinkel, J. ;
Both, M. ;
Noelle, B. ;
Holl-Ulrich, K. ;
Lamprecht, P. ;
Gross, W. L. .
ANNALS OF THE RHEUMATIC DISEASES, 2006, 65 (07) :853-858
[2]   Rituximab With or Without a Conventional Maintenance Agent in the Treatment of Relapsing Granulomatosis With Polyangiitis (Wegener's) [J].
Azar, Lama ;
Springer, Jason ;
Langford, Carol A. ;
Hoffman, Gary S. .
ARTHRITIS & RHEUMATOLOGY, 2014, 66 (10) :2862-2870
[3]  
Baslund B, 2012, CLIN EXP RHEUMATOL, V30, pS7
[4]   Long-term efficacy and safety of pre-emptive maintenance therapy with rituximab in granulomatosis with polyangiitis: results from a single centre [J].
Besada, Emilio ;
Koldingsnes, Wenche ;
Nossent, Johannes C. .
RHEUMATOLOGY, 2013, 52 (11) :2041-2047
[5]  
Brihaye B, 2007, CLIN EXP RHEUMATOL, V25, pS23
[6]   Rituximab for induction and maintenance therapy in granulomatosis with polyangiitis (Wegener's). Results of a single-center cohort study on 66 patients [J].
Calich, Ana Luisa ;
Puechal, Xavier ;
Pugnet, Gregory ;
London, Jonathan ;
Terrier, Benjamin ;
Charles, Pierre ;
Mouthon, Luc ;
Guillevin, Loic .
JOURNAL OF AUTOIMMUNITY, 2014, 50 :135-141
[7]   Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Predictors of Respiratory Failure and Clinical Outcomes [J].
Cartin-Ceba, Rodrigo ;
Diaz-Caballero, Luis ;
Al-Qadi, Mazen O. ;
Tryfon, Stavros ;
Fervenza, Fernando C. ;
Ytterberg, Steven R. ;
Specks, Ulrich .
ARTHRITIS & RHEUMATOLOGY, 2016, 68 (06) :1467-1476
[8]   Rituximab for remission induction and maintenance in refractory granulomatosis with polyangiitis (Wegener's) Ten-year experience at a single center [J].
Cartin-Ceba, Rodrigo ;
Golbin, Jason M. ;
Keogh, Karina A. ;
Peikert, Tobias ;
Sanchez-Menendez, Marta ;
Ytterberg, Steven R. ;
Fervenza, Fernando C. ;
Specks, Ulrich .
ARTHRITIS AND RHEUMATISM, 2012, 64 (11) :3770-3778
[9]   Rituximab for induction and maintenance treatment of ANCA-associated vasculitides: a multicentre retrospective study on 80 patients [J].
Charles, Pierre ;
Neel, Antoine ;
Tieulie, Nathalie ;
Hot, Arnaud ;
Pugnet, Gregory ;
Decaux, Olivier ;
Marie, Isabelle ;
Khellaf, Mehdi ;
Kahn, Jean-Emmanuel ;
Karras, Alexandre ;
Ziza, Jean-Marc ;
Deligny, Christophe ;
Tcherakian, Colas ;
Guillevin, Loic .
RHEUMATOLOGY, 2014, 53 (03) :532-539
[10]   Rituximab use in patients with ANCA-associated vasculitis: clinical efficacy and impact on immunological parameters [J].
Chocova, Z. ;
Hruskova, Z. ;
Mareckova, H. ;
Svobodova, B. ;
Duskova, D. ;
Bednarova, V. ;
Jancova, E. ;
Rysava, R. ;
Tesar, V. .
CLINICAL RHEUMATOLOGY, 2015, 34 (01) :107-115