Drs. Puéchal, Guillevin, and Mariette have received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Roche.
Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: Results from the Autoimmunity and Rituximab Registry
Article first published online: 28 FEB 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 3, pages 331–339, March 2012
How to Cite
Puéchal, X., Gottenberg, J. E., Berthelot, J. M., Gossec, L., Meyer, O., Morel, J., Wendling, D., de Bandt, M., Houvenagel, E., Jamard, B., Lequerré, T., Morel, G., Richette, P., Sellam, J., Guillevin, L., Mariette, X. and Investigators of the Autoimmunity Rituximab Registry (2012), Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: Results from the Autoimmunity and Rituximab Registry. Arthritis Care Res, 64: 331–339. doi: 10.1002/acr.20689
- Issue published online: 28 FEB 2012
- Article first published online: 28 FEB 2012
- Accepted manuscript online: 10 NOV 2011 02:44PM EST
- Manuscript Accepted: 2 NOV 2011
- Manuscript Received: 5 SEP 2011
- The French AutoImmunity and Rituximab registry receives financial support in the form of an unrestricted educational grant from Roche
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).
We analyzed data from the AutoImmunity and Rituximab registry, which includes patients with autoimmune diseases treated with rituximab.
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.
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.