ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2383

Rituximab As Induction and Maintenance Therapies for ANCA-Associated Vasculitis: A Multicenter Retrospective Study On 80 Patients

Pierre Charles1, Antoine Néel2, Nathalie Tieulié3, Arnaud Hot4, Grégory Pugnet5, Olivier Decaux6, Isabelle Marie7, Mehdi Khellaf8, Jean-Emmanuel Kahn9, Alexandre Karras10, Jean-Marc Ziza11, Christophe Deligny12, Colas Tchérakian13 and Loic Guillevin14, 1Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, Paris, France, 2Internal Medicine, Nantes University Hospital, Nantes, France, 3CHU Nice, Nice, France, 4Internal Medicine, Edouard Herriot University Hospital, Lyon, France, 5Department of Internal Medicine, Toulouse University Hospital, University of Toulouse, INSERM UMR 1027, Toulouse, France, 6Department of Internal Medicine, Rennes University Hospital, Rennes, France, 7Service de médecine interne, CHU de Rouen, Rouen, France., Rouen, France, 8Internal Medicine, Service de médecine interne, Université Paris Est Créteil, AP-HP, Hôpital Mondor Créteil, France, Creteil, France, 9Internal Medicine, Foch Hospital, Suresnes, France, 10Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France, 11Rheumatology, Croix Saint Simon Hospital, Paris, France, 12Rhumatologie Et Médecine Interne, Centre hospitalier Universitaire de Fort de France, Fort de France, Martinique, 13Service de pneumologie, hôpital Foch, Suresnes, France, 14Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, Paris, France

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Rituximab has been shown to induce remission of ANCA-associated vasculitis (AAV). Our study was undertaken to 1) describe the clinical response of AAV to rituximab used for remission-induction and/or maintenance therapy, 2) assess rituximab’s safety profile, and 3) evaluate French clinical practices (choice of rituximab, modalities of its use and monitoring).

Methods: This retrospective cohort study concerned AAV patients who had received at least 1 rituximab infusion, between 2002 and January 2011, and all patients had at least 12 months of follow-up.

Results: Eighty patients were included, most had refractory or relapsing AAV: 70 (88%) had granulomatosis with polyangiitis (GPA), 9 (11%) had microscopic polyangiitis (MPA), 1 (1%) had eosinophilic granulomatosis with polyangiitis (EGPA). Rituximab was first prescribed to induce remission in 73 patients. The 2 most commonly administered regimens were: 1 infusion of 375 mg/m2/week for 4 weeks (55 patients) and 1 infusion of 1 g every 2 weeks for a month (17 patients). Rituximab was first prescribed to maintain remission in 7 patients, usually at a dose of 500 mg every 6 months. Relapse-free survival rates at 1, 2 and 3 years after the first rituximab infusion were, respectively, 80% (95% CI 72–89), 63% (95% CI 51–77) and 52% (95% CI 39–70). A trend towards rituximab superiority as maintenance therapy was observed: 9/45 (20%) patients given rituximab relapsed vs 7/14 (50%) prescribed various other therapies (p = 0.13). Twenty-two (27.5%) rituximab-treated patients experienced a severe adverse event. Among them, 12 (15%) had infectious complications leading to 4 (5%) deaths. Only 15 (19%) patients had received anti-pneumococcal vaccine before the first rituximab infusion.

Conclusion: Rituximab was able to induce AAV remission in already immunodepressed patients and seems to be superior to other therapies at maintaining remission. However, caution is needed concerning its safety, especially bacterial infections, in this immunosuppressant-treated population.

Disclosure:

P. Charles,
None;

A. Néel,
None;

N. Tieulié,
None;

A. Hot,
None;

G. Pugnet,
None;

O. Decaux,
None;

I. Marie,
None;

M. Khellaf,
None;

J. E. Kahn,
None;

A. Karras,
None;

J. M. Ziza,
None;

C. Deligny,
None;

C. Tchérakian,
None;

L. Guillevin,
None.

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