Drs. Keogh, Peikert, Ytterberg, and Fervenza were site coinvestigators on the Rituximab in ANCA-Associated Vasculitis (RAVE) trial, for which only Drs. Ytterberg and Fervenza received support.
Rituximab for remission induction and maintenance in refractory granulomatosis with polyangiitis (Wegener's): Ten-year experience at a single center
Article first published online: 27 OCT 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 11, pages 3770–3778, November 2012
How to Cite
Cartin-Ceba, R., Golbin, J. M., Keogh, K. A., Peikert, T., Sánchez-Menéndez, M., Ytterberg, S. R., Fervenza, F. C. and Specks, U. (2012), Rituximab for remission induction and maintenance in refractory granulomatosis with polyangiitis (Wegener's): Ten-year experience at a single center. Arthritis & Rheumatism, 64: 3770–3778. doi: 10.1002/art.34584
- Issue published online: 27 OCT 2012
- Article first published online: 27 OCT 2012
- Accepted manuscript online: 21 JUN 2012 09:25AM EST
- Manuscript Accepted: 7 JUN 2012
- Manuscript Received: 12 APR 2011
This study was conducted to evaluate the efficacy and safety of repeated and prolonged B cell depletion with rituximab (RTX) for the maintenance of long-term remission in patients with chronic relapsing granulomatosis with polyangiitis (Wegener's) (GPA).
We conducted a single-center observational study of all patients with chronic relapsing GPA treated with at least 2 courses of RTX between January 1, 2000 and May 31, 2010. Participants in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial were excluded from this analysis. Data were abstracted from electronic medical records.
Fifty-three patients with refractory GPA (median age 46 years [interquartile range (IQR) 30–61 years]; 53% women) received at least 2 courses of RTX to treat GPA relapses or to maintain remission. All but 1 patient had antineutrophil cytoplasmic antibodies (ANCA) against proteinase 3 (PR3). These patients received a median of 4 courses of RTX (IQR 3–5); all had depletion of B cells, and the median time to return of B cells was 8.5 months (IQR 6–11 months). All observed relapses occurred after reconstitution of B cells and were accompanied or preceded by an increase in ANCA levels, except for the 1 ANCA-negative patient. Infusion-related adverse events occurred in 16 patients. During the period of B cell depletion, 30 infections requiring antimicrobial therapy were recorded.
RTX appeared to be effective and safe for the induction and maintenance of remission in patients with chronic relapsing GPA. Repeated depletion of B lymphocytes seems to be associated with a low risk of infections. Preemptive re-treatment decisions can be individualized based on serial B lymphocyte and PR3 ANCA monitoring. The use of RTX for the maintenance of long-term remission merits further formal investigation.