| Abstract | Extensive Wegener's granulomatosis (WG) is treated by glucocorticosteroids (GC) and cyclophosphamide (CYC). In some cases, the disease is refractory to CYC. For those patients the depletion of B-lymphocytes with rituximab is a promising new treatment modality. This is a retrospective study of six patients receiving rituximab (RTX) with 4 x 375 mg/m(2) body surface weekly because of inefficacy of CYC. Proteinase-3-antineutrophil cytoplasmic antibodies (PR3-ANCA) and c-ANCAs were assessed. For clinical follow-up the Birmingham Vasculitis Activity Score for WG (BVAS/WG) was used. In five of the six cases, leflunomide (LEF) was given as maintenance treatment. Mean follow up was 16 months (12-21 months). The median PR3-ANCA titer fell from 36.8 U/ml at baseline to 21.4 U/ml after 3 months, 8.3 after 6 months, and 4.3 at month 12. The median BVAS/WG at baseline was 5 and 0 after 1 month. Two minor relapses could be noticed at month 3. After 6 months, one patient still had a BVAS of 1, all the others had a BVAS of 0. At month 18, a major relapse occurred in one patient, which was successfully retreated with RTX. The RTX infusions were well tolerated. Rituximab is a well-tolerated, very effective medication for patients with Wegener's granulomatosis. Leflunomide maintenance may increase the efficacy of rituximab and prolong the disease-free period. |
| Authors | J C Henes, J Fritz, S Koch, R Klein, M Horger, T Risler, L Kanz, I Koetter
(Affiliation: Department of Internal Medicine II ,University Hospital, Otfried-Mueller-Str. 10, 72076, Tuebingen, Germany.)
|
| Journal | Clinical rheumatology
(Clin Rheumatol)
Vol. 26
Issue 10
Pg. 1711-5
(Oct 2007)
ISSN: 0770-3198 Belgium |
| PMID | 17502992
(Publication Type: Journal Article)
|
| Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Antibodies, Monoclonal
- Antirheumatic Agents
- Isoxazoles
- rituximab
- leflunomide
|
| Topics |
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal
(therapeutic use)
- Antibodies, Monoclonal
(therapeutic use)
- Antirheumatic Agents
(therapeutic use)
- B-Lymphocytes
(drug effects)
- Disease-Free Survival
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Humans
- Isoxazoles
(therapeutic use)
- Magnetic Resonance Imaging
(methods)
- Male
- Middle Aged
- Radiography, Thoracic
(methods)
- Recurrence
- Retrospective Studies
- Tomography, X-Ray Computed
(methods)
- Wegener Granulomatosis
(drug therapy)
|
