Long-term effects of rituximab added to cyclophosphamide in refractory patients with vasculitis

Am J Nephrol. 2011;34(2):175-80. doi: 10.1159/000329535. Epub 2011 Jul 8.

Abstract

Background: Current therapies have changed systemic vasculitis from a disease with a high rate of mortality to a chronic curable condition. A limited percentage of patients either remains refractory to conventional treatment or experiences dose-limiting side effects.

Methods: 11 patients (4 affected by idiopathic systemic microscopic polyangiitis, 5 by Wegener's granulomatosis, and 2 by Churg-Strauss syndrome) intolerant or refractory to conventional therapies including cyclophosphamide were enrolled. All patients received rituximab as a rescue therapy and were followed for 30-54 months. Following rituximab administration, immunosuppressive drugs were rapidly tapered and no immunosuppressive maintenance therapy was given.

Results: Significant decreases in levels of serum creatinine, proteinuria, erythrocyte sedimentation rate, C-reactive protein, and ANCA titers were observed during the follow-up (at least 30 months after rituximab administration). Arthralgia and weakness rapidly disappeared in all patients. Out of 7 patients, 5 reported a decrease in the degree of paresthesia and in the electrophysiologic parameters. Six months after rituximab administration the mean dose of prednisone was 5.5 mg/day.

Conclusion: In this sample of patients with systemic vasculitis who were refractory or intolerant to more conventional treatment, rituximab proved to be safe and effective in a long-term follow-up, and showed steroid- and immunosuppressive-sparing effects allowing the persistence of long-lasting remissions without maintenance therapy.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage*
  • Antirheumatic Agents / administration & dosage
  • Cohort Studies
  • Cyclophosphamide / administration & dosage*
  • Drug Therapy, Combination / methods*
  • Electrophysiology / methods
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Rituximab
  • Treatment Outcome
  • Vasculitis / drug therapy*
  • Vasculitis / pathology

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Immunosuppressive Agents
  • Rituximab
  • Cyclophosphamide