Rheumatoid Arthritis

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

  1. X. Puéchal1,‡,*,
  2. J. E. Gottenberg2,§,
  3. J. M. Berthelot3,¶,
  4. L. Gossec4,
  5. O. Meyer5,
  6. J. Morel6,‖,
  7. D. Wendling7,††,
  8. M. de Bandt8,
  9. E. Houvenagel9,
  10. B. Jamard10,
  11. T. Lequerré11,
  12. G. Morel12,
  13. P. Richette13,
  14. J. Sellam14,‡‡,
  15. L. Guillevin15,‡,
  16. X. Mariette16,
  17. Investigators of the Autoimmunity Rituximab Registry

Article first published online: 28 FEB 2012

DOI: 10.1002/acr.20689

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 64, Issue 3, pages 331–339, March 2012

Additional Information

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

Author Information

  1. 1

    Le Mans General Hospital, Le Mans, and Cochin Hospital, Paris, France

  2. 2

    Hautepierre Hospital, Strasbourg, France

  3. 3

    Hotel-Dieu Hospital, Nantes, France

  4. 4

    AP-HP, Cochin Hospital, Paris Descartes University, Paris, France

  5. 5

    AP-HP, Bichat Hospital, Paris, France

  6. 6

    Lapeyronie Hospital, Montpellier, France

  7. 7

    Jean Minjoz Hospital, Besançon, France

  8. 8

    Aulnay Hospital, Aulnay, France

  9. 9

    Saint-Philibert Hospital, Lomme, France

  10. 10

    Purpan Hospital, Toulouse, France

  11. 11

    Bois-Guillaume Hospital, Rouen, France

  12. 12

    Valenciennes Hospital, Valenciennes, France

  13. 13

    AP-HP, Lariboisière Hospital, Paris Diderot University, Sorbonne Paris Cité, Paris, France

  14. 14

    AP-HP, Saint-Antoine Hospital, Pierre, and Marie Curie University, Paris, France

  15. 15

    AP-HP, Cochin Hospital, Paris, France

  16. 16

    AP-HP, Bicêtre Hospital, Paris-Sud University, INSERM U1012, Le Kremlin-Bicêtre, France

  1. ‡

    Drs. Puéchal, Guillevin, and Mariette have received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Roche.

  2. §

    Dr. Gottenberg has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Bristol-Meyers Squibb, MSD, Pfizer, and Roche.

  3. Dr. Berthelot has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Roche.

  4. ‖

    Dr. J. Morel has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Bristol-Meyers Squibb, Durga, MSD, Nordic, Pfizer, and Roche.

  5. ††

    Dr. Wendling has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Bristol-Meyers Squibb, Pfizer, Roche Chugai, Amgen, Schering Plough, Sanofi Aventis, Novartis, and Nordic Pharma.

  6. ‡‡

    Dr. Sellam has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from MSD, Pfizer, and Roche.

*Center for Rare Systemic Autoimmune Diseases, Department of Rheumatology, Le Mans General Hospital, 194 Avenue Rubillard, 72000 Le Mans, France

Publication History

  1. Issue published online: 28 FEB 2012
  2. Article first published online: 28 FEB 2012
  3. Accepted manuscript online: 10 NOV 2011 02:44PM EST
  4. Manuscript Accepted: 2 NOV 2011
  5. Manuscript Received: 5 SEP 2011

Funded by

  • The French AutoImmunity and Rituximab registry receives financial support in the form of an unrestricted educational grant from Roche

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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.

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