Rituximab Found Effective But Risky for Vasculitis

Charles P, Néel A, Tieulié N, et al., on behalf of the French Vasculitis Study Group. Rituximab for induction and maintenance treatment of ANCA-associated vasculitides: a multicenter retrospective study on 80 patients.Rheumatology (Oxford). Published online ahead of print November 26, 2013.

Rituximab appears effective at inducing and maintaining remission in ANCA-positive vasculitis (AAV), but patients must be monitored for risk of serious bacterial and fungal infections, according to a recent study from France.

The multicenter, retrospective study by the French Vasculitis Study Group reported complete remission among 60% of 80 AAV patients who received one or more rituximab infusions between January 2002 and January 2011. The patients were followed for at least a year.

Twenty two of these patients (28%) experienced serious adverse events, most often serious infections, which led to four deaths.

The majority of study patients (mean age 53) had refractory or relapsing AAV, most with granulomatosis polyangiitis. More than half of patients experienced one or more prior relapses.

The most common regimens were an infusion of 375 mg/m²/week for 4 weeks or a 1 g infusion every 2 weeks for a month. Rituximab was chosen as the first-line agent to induce remission in 73 patients.

By 6 months after the first infusion, 66% of patients were in complete remission, as were 71% after a year.

Relapse-free survival rates were 80% at 1 year, 63% at 2 years, and 52% at 3 years. Patients who received rituximab as maintenance therapy experienced a longer relapse-free period.

European League Against Rheumatism (EULAR) definitions were used for remission and relapse.

All but one patient received immunosuppressants prior to rituximab, most commonly cyclophosphamide or azathioprine; 25% had concomitant immunosuppressive therapy.