Rituximab for eosinophilic granulomatosis with polyangiitis with severe vasculitic neuropathy: Case report and review of current clinical evidence.

Abstract

OBJECTIVE:

Rituximab is approved for the treatment of granulomatosis with polyangiitis and microscopic polyangiitis. Our objective was to review published clinical evidence on the efficacy of rituximab in the treatment of eosinophilic granulomatosis and polyangiitis (EGPA).

METHODS:

We describe a case of refractory EGPA with severe vasculitic neuropathy, which responded impressively to B-cell-depleting therapy. A systematic search of the English literature was also performed to capture all available clinical evidence on the use of rituximab in EGPA.

RESULTS:

We identified a total of 73 EGPA patients who have been treated with rituximab, all data coming from case series or isolated case reports. The majority of patients (85.1%) were treated for refractory or relapsing disease; a mean (SD) of 2.1 (0.9) different immunosuppressive agents were used prior to rituximab administration. Efficacy of RTX therapy was significant in the majority of cases and in a wide variety of disease manifestations; however, a lack of standardized assessment of disease activity before and after treatment was observed in many reports. Overall, 54.0% of patients were treated with a single cycle of rituximab and only 10.8% experienced relapses of the disease. Few significant side effects were observed during a highly variable period of follow-up (3 months to 5 years), mainly severe infections and allergic reactions.

CONCLUSIONS:

RTX seems to be effective in cases of severe EGPA refractory to standard of care immunosuppressive treatment, although support comes from case reports and non-controlled studies.

• Authors: Antonis Fanouriakis, Nikolaos Kougkas, Dimitrios Vassilopoulos, Eleni Fragouli, Argyro Repa, Prodromos Sidiropoulos
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 45 Issue 1 Pg. 60-6 (Aug 2015) ISSN: 1532-866X [Electronic] United States
• PMID: 25908179 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Immunosuppressive Agents
• Rituximab

Topics

• Churg-Strauss Syndrome (drug therapy)
• Granulomatosis with Polyangiitis (drug therapy)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Rituximab (therapeutic use)