Abstract | OBJECTIVE: To evaluate the efficacy and safety of rituximab (RTX) induction therapy and the duration of remission, when RTX is used with or without a conventional maintenance agent, in a cohort of patients with granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: This was a retrospective, single-center study of patients with relapsing GPA treated with at least 1 course of RTX (4 weekly doses of 375 mg/m(2) intravenously [IV] or 2 fixed doses of 1,000 mg IV 2 weeks apart). Complete remission was defined as the absence of disease activity measured by a Birmingham Vasculitis Activity Score for Wegener's granulomatosis of 0 and not qualified by the prednisone dosage at the time. RESULTS: Eighty-nine patients achieved remission after their first course of RTX and were not re-treated preemptively with RTX to maintain remission of their disease during followup. Among these patients, relapse-free survival was significantly higher in those who received a conventional maintenance agent ( azathioprine, methotrexate, or mycophenolate mofetil) in conjunction with RTX and glucocorticoids (n = 47) than in those who received no additional immunosuppressive agent (n = 42) (P = 0.04). The hazard ratio of relapse in those receiving a maintenance agent was 0.53 (95% confidence interval 0.29-0.97). Serious adverse events did not differ between the 2 groups. Within a subset of 15 patients in the cohort who were relapse free 2 years after 1 course of RTX, remissions endured for 2-6 years in 8 patients. CONCLUSION: RTX is an effective remission-inducing agent in GPA. The addition of a conventional maintenance agent to RTX and glucocorticoids decreased the incidence of relapse and did not result in a higher incidence of adverse events.
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Authors | Lama Azar, Jason Springer, Carol A Langford, Gary S Hoffman |
Journal | Arthritis & rheumatology (Hoboken, N.J.)
(Arthritis Rheumatol)
Vol. 66
Issue 10
Pg. 2862-70
(Oct 2014)
ISSN: 2326-5205 [Electronic] United States |
PMID | 24943239
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 by the American College of Rheumatology. |
Chemical References |
- Antibodies, Monoclonal, Murine-Derived
- Immunologic Factors
- Rituximab
- Mycophenolic Acid
- Azathioprine
- Methotrexate
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Topics |
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived
(therapeutic use)
- Azathioprine
(therapeutic use)
- Drug Therapy, Combination
- Female
- Granulomatosis with Polyangiitis
(drug therapy)
- Humans
- Immunologic Factors
(therapeutic use)
- Male
- Methotrexate
(therapeutic use)
- Middle Aged
- Mycophenolic Acid
(analogs & derivatives, therapeutic use)
- Remission Induction
- Retrospective Studies
- Rituximab
- Treatment Outcome
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