Drs. R. M. Smith and R. B. Jones contributed equally to this work.
Rituximab for remission maintenance in relapsing antineutrophil cytoplasmic antibody–associated vasculitis
Version of Record online: 27 OCT 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 11, pages 3760–3769, November 2012
How to Cite
Smith, R. M., Jones, R. B., Guerry, M.-J., Laurino, S., Catapano, F., Chaudhry, A., Smith, K. G. C. and Jayne, D. R. W. (2012), Rituximab for remission maintenance in relapsing antineutrophil cytoplasmic antibody–associated vasculitis. Arthritis & Rheumatism, 64: 3760–3769. doi: 10.1002/art.34583
- Issue online: 27 OCT 2012
- Version of Record online: 27 OCT 2012
- Accepted manuscript online: 21 JUN 2012 09:25AM EST
- Manuscript Accepted: 7 JUN 2012
- Manuscript Received: 14 MAY 2011
- NIHR Cambridge Biomedical Research Centre
Rituximab is effective induction therapy in refractory or relapsing antineutrophil cytoplasmic antibody–associated vasculitis (AAV). However, further relapse is common, and maintenance strategies are required. The aim of this study was to reduce relapse rates using a fixed-interval rituximab re-treatment protocol.
Retrospective, standardized collection of data from sequential patients receiving rituximab for refractory or relapsing AAV at a single center was studied. Group A patients (n = 28) received rituximab induction therapy (4 infusions of 375 mg/m2 or 2 infusions 1 gm) and further rituximab at the time of subsequent relapse. Group B patients (n = 45) received routine rituximab re-treatment for 2 years: 2 doses of 1 gm each for remission induction, then 1 gm every 6 months (total of 6 gm). Group C patients (n = 19) comprised patients in group A who subsequently relapsed and began routine re-treatment for 2 years.
Response (complete/partial remission) occurred in 26 of the 28 patients (93%) in group A, 43 of the 45 patients (96%) in group B, and 18 of the 19 patients (95%) in group C. At 2 years, relapses had occurred in 19 of 26 patients (73%) in group A, 5 of 43 (12%) in group B (P < 0.001), and 2 of 18 (11%) in group C (P < 0.001). At the last followup (median of 44 months), relapses had occurred in 85% of those in group A (22 of 26), 26% of those in group B (11 of 43; P < 0.001), and 56% of those in group C (10 of 18; P = 0.001). Glucocorticoid dosages were decreased and immunosuppression therapy was withdrawn in the majority of patients. Routine rituximab re-treatment was well tolerated, and no new safety issues were identified.
Two-year, fixed-interval rituximab re-treatment was associated with a reduction in relapse rates during the re-treatment period and a more prolonged period of remission during subsequent followup. In the absence of biomarkers that accurately predict relapse, routine rituximab re-treatment may be an effective strategy for remission maintenance in patients with refractory and relapsing AAV.