Long-term effects of rituximab added to cyclophosphamide in refractory patients with vasculitis.

Abstract

BACKGROUND:

Current therapies have changed systemic vasculitis from a disease with a high rate of mortality to a chronic curable condition. A limited percentage of patients either remains refractory to conventional treatment or experiences dose-limiting side effects.

METHODS:

11 patients (4 affected by idiopathic systemic microscopic polyangiitis, 5 by Wegener's granulomatosis, and 2 by Churg-Strauss syndrome) intolerant or refractory to conventional therapies including cyclophosphamide were enrolled. All patients received rituximab as a rescue therapy and were followed for 30-54 months. Following rituximab administration, immunosuppressive drugs were rapidly tapered and no immunosuppressive maintenance therapy was given.

RESULTS:

Significant decreases in levels of serum creatinine, proteinuria, erythrocyte sedimentation rate, C-reactive protein, and ANCA titers were observed during the follow-up (at least 30 months after rituximab administration). Arthralgia and weakness rapidly disappeared in all patients. Out of 7 patients, 5 reported a decrease in the degree of paresthesia and in the electrophysiologic parameters. Six months after rituximab administration the mean dose of prednisone was 5.5 mg/day.

CONCLUSION:

In this sample of patients with systemic vasculitis who were refractory or intolerant to more conventional treatment, rituximab proved to be safe and effective in a long-term follow-up, and showed steroid- and immunosuppressive-sparing effects allowing the persistence of long-lasting remissions without maintenance therapy.

• Authors: Dario Roccatello, Savino Sciascia, Daniela Rossi, Mirella Alpa, Carla Naretto, Alessandra Russo, Elisa Menegatti, Simone Baldovino
• Journal: American journal of nephrology (Am J Nephrol) Vol. 34 Issue 2 Pg. 175-80 ( 2011) ISSN: 1421-9670 [Electronic] Switzerland
• PMID: 21757891 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 S. Karger AG, Basel.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antirheumatic Agents
• Immunosuppressive Agents
• Rituximab
• Cyclophosphamide

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antirheumatic Agents (administration & dosage)
• Cohort Studies
• Cyclophosphamide (administration & dosage)
• Drug Therapy, Combination (methods)
• Electrophysiology (methods)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Rituximab
• Treatment Outcome
• Vasculitis (drug therapy, pathology)