Background/Purpose:

To evaluate the long term outcomes, of patients with multi-relapsing Antineutrophil Cytoplasmic Antibody (ANCA) associated Vasculitis (AAV), who received induction therapy with a rituximab regimen upon disease relapse versus a control group who received the standard regimen.

Methods:

We studied patients with biopsy proven AAV, and a history of frequent relapses of the disease, who were treated with a rituximab regimen upon relapsing vasculitis. Rituximab was typically used in combination with the standard regimen for patients with major relapses or with glucocorticoids alone for minor relapses. A control group consisted of patients from the era prior to the initiation of rituximab in the treatment of AAV, was selected, using the following criteria; history of relapse, organ involvement at relapse, treatment with the standard regimen (cyclophosphamide plus glucocorticoids). Patients and controls were also matched for age, gender, and disease duration. Comparisons of outcomes, along with the frequency and severity of adverse events were performed between groups.

Results:

Of 147 patients with biopsy proven AAV and a mean total follow up time of 78.2 months, we identified 18 patients (12.2%), who received induction treatment with rituximab for disease relapse. A control group of equal size was selected. Organ involvement and disease activity were similar between groups at entry. The mean number of relapses per patient was significantly higher in this group for the same period compared to the control group. 13/18 patients in the rituximab group received the standard regimen in addition to rituximab as inductive therapy. Patients in both groups achieved remission in similar rates but patients in the rituximab group showed a significant decline in the number of relapses per patient [median, (range): 2(1-4)] compared to the number of relapses per patient in the period prior to therapy with rituximab [0(0-1), p<0.001]. As a result, the subsequent exposure to cyclophopshamide was radically decreased in this group [median, (range): 21.75 grams (4.0-177.0) vs. 3(0.0-10.5), p<0.0001].

Conclusion:

In our experience, rituximab was shown efficacious in achievement of long term remission in patients with a history multiple relapsing AAV and allowed us to minimize the ultimate exposure to cyclophosphamide in these patients, avoiding further accumulation of toxicity.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rituximab-as-a-cyclophosphimide-sparing-agent-for-patients-with-multi-relapsing-antineutrophil-cytoplasmic-antibody-associated-small-vessel-vasculitis/