Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: Results from the AutoImmunity and Rituximab Registry.

Abstract

OBJECTIVE:

Rituximab improves articular symptoms in rheumatoid arthritis (RA) and it recently has been shown to be an effective induction therapy for antineutrophil cytoplasmic antibody-associated vasculitis. We assessed the efficacy and safety of rituximab in a real-life clinical setting among patients with systemic rheumatoid vasculitis (SRV).

METHODS:

We analyzed data from the AutoImmunity and Rituximab registry, which includes patients with autoimmune diseases treated with rituximab.

RESULTS:

Of the 1,994 patients with RA enrolled in the registry, 17 were treated with rituximab for active SRV. At baseline, the mean Birmingham Vasculitis Activity Score for RA (BVAS/RA) was 9.6, with a mean prednisone dosage of 19.2 mg/day. After 6 months of rituximab therapy, 12 patients (71%) achieved complete remission of their vasculitis, 4 had a partial response, and 1 died with uncontrolled vasculitis. Mean BVAS/RA was reduced to 0.6 and mean prednisone dosage to 9.7 mg/day. At 12 months, 14 patients (82%) were in sustained complete remission. Severe infection occurred in 3 patients, corresponding to a 6.4 per 100 patient-years rate. In the 6 patients who received further rituximab as maintenance therapy between months 6 and 12, no relapse of vasculitis was observed. However, among the 9 patients who did not, a relapse was observed in 3 patients who were treated with methotrexate alone. Remission was reestablished by reintroducing rituximab in 2 cases.

CONCLUSION:

Complete remission of SRV was achieved in nearly three-fourths of patients receiving rituximab in daily practice, with a significant decrease in daily prednisone dosage and an acceptable toxicity profile. Rituximab represents a suitable therapeutic option to induce remission in SRV, but maintenance therapy seems to be necessary.

• Authors: X Puéchal, J E Gottenberg, J M Berthelot, L Gossec, O Meyer, J Morel, D Wendling, M de Bandt, E Houvenagel, B Jamard, T Lequerré, G Morel, P Richette, J Sellam, L Guillevin, X Mariette, Investigators of the AutoImmunity Rituximab Registry
• Journal: Arthritis care & research (Arthritis Care Res (Hoboken)) Vol. 64 Issue 3 Pg. 331-9 (Mar 2012) ISSN: 2151-4658 [Electronic] United States
• PMID: 22076726 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 by the American College of Rheumatology.

Chemical References

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

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy)
• Female
• Humans
• Male
• Middle Aged
• Registries
• Rituximab
• Systemic Vasculitis (complications, drug therapy)
• Treatment Outcome