Rituximab plus methotrexate combination as a salvage therapy in persistently active granulomatosis with polyangiitis.

Abstract

OBJECTIVE:

The aim of this study was to describe the efficacy and safety of rituximab and MTX (RTX/MTX) combination therapy in ANCA-associated vasculitides (AAV).

METHODS:

A retrospective French nationwide study was conducted in patients with AAV who received RTX/MTX combination therapy for persistently active disease.

RESULTS:

Seventeen patients were included. All patients had granulomatosis with polyangiitis (GPA), with positive ANCA in 76% of them, mainly with PR3-ANCA specificity. Sixteen patients (94%) had priorly failed to achieve remission with RTX and 11 (65%) with CYC. Patients had experienced a median of 3 (2-4) flares. Manifestations requiring RTX/MTX combination therapy were subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case (6%) each. The median follow-up duration for the RTX/MTX combination therapy was 11 months (11-26 months). At 6 months, global response had been achieved in 15 patients (88%), including partial response in 11 (65%) and complete response in 4 (24%). At last evaluation, global response had been achieved in 16 patients (94%). Seven patients (41%) experienced severe adverse events (grade 3 or 4), including infections in 4 (24%) and hepatitis in 2 (12%). Combination therapy was withdrawn in 4 patients (24%), but never for safety concerns. In contrast, the MTX dose was decreased in 2 patients (12%) because of adverse events. One patient died of an unknown cause.

CONCLUSION:

RTX/MTX combination therapy could be an effective salvage therapy to treat persistently active GPA with granulomatous manifestations, with an acceptable safety profile.

• Authors: Boris Sorin, Maxime Samson, Cécile-Audrey Durel, Elisabeth Diot, Isabelle Guichard, Aurélie Grados, Nicolas Limal, Alexis Régent, Pascal Cohen, Jérémie Dion, Paul Legendre, Véronique Le Guern, Luc Mouthon, Loïc Guillevin, Benjamin Terrier, French Vasculitis Study Group (FVSG)
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 61 Issue 6 Pg. 2619-2624 (05 30 2022) ISSN: 1462-0332 [Electronic] England
• PMID: 34698818 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Rituximab
• Methotrexate

Topics

• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (drug therapy)
• Antibodies, Antineutrophil Cytoplasmic
• Granulomatosis with Polyangiitis (drug therapy)
• Humans
• Methotrexate (therapeutic use)
• Remission Induction
• Retrospective Studies
• Rituximab (therapeutic use)
• Salvage Therapy
• Treatment Outcome