PMID- 22729997
OWN - NLM
STAT- MEDLINE
DCOM- 20130110
LR  - 20220409
IS  - 1529-0131 (Electronic)
IS  - 0004-3591 (Linking)
VI  - 64
IP  - 11
DP  - 2012 Nov
TI  - Rituximab for remission maintenance in relapsing antineutrophil cytoplasmic 
      antibody-associated vasculitis.
PG  - 3760-9
LID - 10.1002/art.34583 [doi]
AB  - OBJECTIVE: 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. METHODS: 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/m(2) 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. 
      RESULTS: 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      dosages were decreased and immunosuppression therapy was withdrawn in the 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. CONCLUSION: 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.
CI  - Copyright (c) 2012 by the American College of Rheumatology.
FAU - Smith, Rona M
AU  - Smith RM
AD  - Addenbrooke's Hospital, Cambridge, UK. ho0919@catholic.ac.kr
FAU - Jones, Rachel B
AU  - Jones RB
FAU - Guerry, Mary-Jane
AU  - Guerry MJ
FAU - Laurino, Simona
AU  - Laurino S
FAU - Catapano, Fausta
AU  - Catapano F
FAU - Chaudhry, Afzal
AU  - Chaudhry A
FAU - Smith, Kenneth G C
AU  - Smith KG
FAU - Jayne, David R W
AU  - Jayne DR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arthritis Rheum
JT  - Arthritis and rheumatism
JID - 0370605
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunoglobulin G)
RN  - 0 (Immunologic Factors)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 9PHQ9Y1OLM (Prednisolone)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*drug 
      therapy/*immunology
MH  - Antibodies, Antineutrophil Cytoplasmic/blood/immunology
MH  - Antibodies, Monoclonal, Murine-Derived/*administration & dosage/adverse effects
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - Female
MH  - Glucocorticoids/administration & dosage
MH  - Humans
MH  - Immunoglobulin G/blood/immunology
MH  - Immunologic Factors/*administration & dosage/adverse effects
MH  - Male
MH  - Middle Aged
MH  - Prednisolone/administration & dosage
MH  - Remission Induction
MH  - Retrospective Studies
MH  - Rituximab
MH  - Secondary Prevention
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2012/06/26 06:00
MHDA- 2013/01/11 06:00
CRDT- 2012/06/26 06:00
PHST- 2012/06/26 06:00 [entrez]
PHST- 2012/06/26 06:00 [pubmed]
PHST- 2013/01/11 06:00 [medline]
AID - 10.1002/art.34583 [doi]
PST - ppublish
SO  - Arthritis Rheum. 2012 Nov;64(11):3760-9. doi: 10.1002/art.34583.