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- Title
Rituximab With or Without a Conventional Maintenance Agent in the Treatment of Relapsing Granulomatosis With Polyangiitis (Wegener's): A Retrospective Single-Center Study.
- Authors
Azar, Lama; Springer, Jason; Langford, Carol A.; Hoffman, Gary S.
- Abstract
Objective To evaluate the efficacy and safety of rituximab (RTX) induction therapy and the duration of remission, when RTX is used with or without a conventional maintenance agent, in a cohort of patients with granulomatosis with polyangiitis (Wegener's) (GPA). Methods This was a retrospective, single-center study of patients with relapsing GPA treated with at least 1 course of RTX (4 weekly doses of 375 mg/m2 intravenously [IV] or 2 fixed doses of 1,000 mg IV 2 weeks apart). Complete remission was defined as the absence of disease activity measured by a Birmingham Vasculitis Activity Score for Wegener's granulomatosis of 0 and not qualified by the prednisone dosage at the time. Results Eighty-nine patients achieved remission after their first course of RTX and were not re-treated preemptively with RTX to maintain remission of their disease during followup. Among these patients, relapse-free survival was significantly higher in those who received a conventional maintenance agent (azathioprine, methotrexate, or mycophenolate mofetil) in conjunction with RTX and glucocorticoids (n = 47) than in those who received no additional immunosuppressive agent (n = 42) ( P = 0.04). The hazard ratio of relapse in those receiving a maintenance agent was 0.53 (95% confidence interval 0.29-0.97). Serious adverse events did not differ between the 2 groups. Within a subset of 15 patients in the cohort who were relapse free 2 years after 1 course of RTX, remissions endured for 2-6 years in 8 patients. Conclusion RTX is an effective remission-inducing agent in GPA. The addition of a conventional maintenance agent to RTX and glucocorticoids decreased the incidence of relapse and did not result in a higher incidence of adverse events.
- Subjects
OHIO; RITUXIMAB; ACADEMIC medical centers; COMBINATION drug therapy; CONFIDENCE intervals; ENZYME-linked immunosorbent assay; FISHER exact test; LONGITUDINAL method; MEDICAL records; HEALTH outcome assessment; REGRESSION analysis; RESEARCH funding; SAFETY; STATISTICS; DATA analysis; GRANULOMATOSIS with polyangiitis; TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; ADVERSE health care events; DESCRIPTIVE statistics; KAPLAN-Meier estimator; THERAPEUTICS
- Publication
Arthritis & Rheumatology, 2014, Vol 66, Issue 10, p2862
- ISSN
2326-5191
- Publication type
Article
- DOI
10.1002/art.38744